The cost implications of academic group practice. A randomized controlled trial.
We evaluated the reorganization of a general medical clinic into several group practices, using equivalent groups of patients and physicians in a randomized controlled trial. The group practice, unlike the traditional clinic, provided decentralized registration, clinic coverage five days a week, and telephone coverage at night and on weekends. Residents worked in small groups with an attending physician, nurse practitioner, and receptionist. All financial activity involving a sample of 2299 patients was followed during the 11-month intervention. The total hospital charges per patient were 26 percent lower for the patients seen in the group practice than for those seen in the traditional clinic (P = 0.003). This difference was primarily attributable to inpatient charges, which were 27 percent lower per patient hospitalized (P = 0.004). The mean length of stay was 8.3 days among group-practice patients and 10.5 days among traditional-clinic patients (P = 0.011). We conclude that organizational changes to improve outpatient access and to integrate inpatient and outpatient services can decrease medical charges.
Cohen
D I
DI
Breslau
D
D
Porter
D K
DK
Goldberg
H I
HI
Dawson
N V
NV
Hershey
C O
CO
Lee
J C
JC
McLaren
C E
CE
Breslau
N
N
D000046:Academic Medical Centers / Q000458:organization & administration*; D003365:Costs and Cost Analysis; D004526:Efficiency; D005249:Fees and Charges; D006123:Group Practice / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007325:Institutional Practice / Q000458:organization & administration; D007902:Length of Stay; D009820:Ohio; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D011897:Random Allocation