Hospital care by hospital-based and clinic-based faculty: a prospective, controlled trial.
BACKGROUND
The hospital length of stay decreases and clinical outcomes are maintained when teaching hospitals involve hospital-based attending physicians in comparison with traditional attending physicians. The attending physician's time commitment, including the number of hours per day and months per year, required to achieve this result is unknown. This study compared the clinical outcomes and cost of care for patients treated by hospital-based and clinic-based attending physicians devoting dramatically different amounts of time to supervising residents on the medical wards of a suburban county hospital.


METHODS
Patients were alternately admitted to 2 groups of ward teams. Faculty who attended 10 months of the year supervised one group. The comparison group's attending physicians were on service for 2 months or less and maintained clinic responsibilities while on service. The cost of patient care was compared by means of the length of stay, total hospital costs, and costs for ancillary services. Hospital mortality and readmission rates compared clinical outcomes.


RESULTS
There were 4456 patients hospitalized on the medical wards of a teaching service. No differences were detected in the length of stay (4.37 +/- 0.1 days for hospital-based and 4.39 +/- 0.1 days for clinic-based attending physicians). Hospital cost was observed to be similar (average cost, $5989 and $5977 per patient, respectively). The clinical outcomes were equivalent, with adjusted mortality rates for hospital-based attending physicians of 3.2% vs 3.9% for clinic-based attending physicians (P =.28).


CONCLUSIONS
An increase of faculty time and involvement for supervision of resident-managed hospital care did not improve clinical outcomes or decrease costs during the 1-year study period.
Kearns
P J
PJ
Department of Medicine, Santa Clara valley Medical Center, San Jose, Calif, USA. pj.keans@med.stanford.edu
Wang
C C
CC
Morris
W J
WJ
Low
D G
DG
Deacon
A S
AS
Chan
S Y
SY
Jensen
W A
WA
D005180:Faculty, Medical; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000191:economics; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D010359:Patient Readmission; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome