Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system.
OBJECTIVE
Previous studies have examined the effects of hospitalists in urban academic hospitals. We compared the outcomes of patients treated by hospitalists with those of patients treated by internists at a 647-bed rural community hospital.


METHODS
The 443 patients in the hospitalists' 10 most common diagnosis-related groups (DRGs) were compared with 1,681 patients in the same DRGs who were cared for by internists in fiscal year 1998. Length of stay, cost of care, patient illness severity, patient satisfaction, 30-day readmission rate, inpatient mortality, discharge status, and resource utilization were compared.


RESULTS
The hospitalists' patients had a shorter mean (+/- SD) length of stay (4.1 +/- 3.0 days versus 5.5 +/- 4.9 days, P <0.001) and their cost of care was less than that of the internists' patients ($4,098 +/- $2,455 versus $4,658 +/- $4,084, P <0.001). Analyses that adjusted for patient age, race, sex, insurance status, severity of illness, and specific medical comorbidities confirmed these differences. The differences between hospitalists and internists were most apparent among very ill patients. Mortality rates were similar (4.5% for hospitalists versus 4.9% for internists, P = 0.80), as were the readmission rates (4.5% for hospitalists versus 5.6% for internists, P = 0.41). Patient satisfaction was similar for both groups. The internists used more resources in 8 of 11 categories.


CONCLUSIONS
The hospitalists provided cost-effective care, particularly for the sickest patients, with good outcomes and patient satisfaction.
Davis
K M
KM
North Mississippi Health Services, Tupelo, Mississippi, USA.
Koch
K E
KE
Harvey
J K
JK
Wilson
R
R
Englert
J
J
Gerard
P D
PD
D006295:Health Resources / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D020445:Hospitalists / Q000191:economics / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay; D008922:Mississippi; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D012720:Severity of Illness Index