The integrated inpatient management model. Lessons for managed care.
The Integrated Inpatient Management Model was a 2.5-year controlled prospective trial of using a clinical information system to direct and monitor physician and hospital practice on general medicine services of an 880-bed university hospital. For the over 2,000 admissions on both a control service and the intervention service, the mean length of stay (LOS) decreased when compared with historic norms (0.68 and 0.95 days respectively; P < 0.01 for both). This difference in mean LOS represents a savings of 580 hospital days for the intervention over the control service; (95% confidence interval, 300 to 1420 days). There also was a trend for the intervention service to have fewer LOS outliers than expected (P = 0.14). Ancillary service use decreased by 17% on both control and intervention services (a trend that disappeared after the study was terminated), while other internal medicine services experienced a 29% increase in this measure of resource use. The intervention service experienced fewer preventable deaths (P = 0.04), but there were no differences in global quality of care measures, readmission and mortality rates, and patient satisfaction. This use of a clinical information system is a prototype for the systems that will be needed for all forms of managed care.
Bernard
A M
AM
Department of Internal Medicine, University of Michigan Hospitals, Ann Arbor, USA.
Hayward
R A
RA
Anderson
J E
JE
Rosevear
J S
JS
McMahon
L F
LF
D000720:Ancillary Services, Hospital / Q000706:statistics & numerical data; D015510:Clinical Medicine / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D003953:Diagnosis-Related Groups; D006748:Hospital Departments / Q000458:organization & administration; D006751:Hospital Information Systems; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008329:Managed Care Programs / Q000458:organization & administration; D008824:Michigan; D017146:Models, Organizational; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011787:Quality of Health Care