The effects of scheduled intern rotation on the cost and quality of teaching hospital care.
We studied the effect of scheduled intern rotations on the cost and quality of inpatient care at one teaching hospital. For all discharges from the internal medicine service between 1980 and 1986, we identified 1,705 rotation patients and 3,141 no-rotation patients. Using linear or logistic regression analysis to control for baseline differences, we evaluated for the effect of rotation. We found that rotation was significantly related to longer length of hospital stay, b = 0.341 days, p = 0.001, and higher hospital charges (for log charges, b = 0.053, p = 0.016. Hospital deaths, nursing home placements, and 30-day readmissions were not significantly related to rotation, p > 0.1. These results suggest that the systematic discontinuity induced by scheduled intern rotations may be another source of increased health care costs experienced at teaching hospitals.
Rich
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General Internal Medicine & Geriatrics, University of Kentucky, Lexington 40536.
Gifford
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Dowd
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B
D003266:Continuity of Patient Care / Q000191:economics* / Q000592:standards; D003625:Data Collection; D005069:Evaluation Studies as Topic; D006302:Health Services Research; D017722:Hospital Charges; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000191:economics* / Q000592:standards*; D006801:Humans; D007388:Internal Medicine; D007396:Internship and Residency / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011787:Quality of Health Care; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology