Effects of an HMO hospitalist program on inpatient utilization.
OBJECTIVE
To assess the impact of a health maintenance organization (HMO) hospitalist program on inpatient utilization.


METHODS
The study sample consisted of patients admitted to the hospital for a routine, uncomplicated acute surgical or medical diagnosis included under Milliman and Robertson's Optimal Recovery Guidelines (ORGs). Evaluation involved comparison of 2 physician management groups: inpatients managed by staff primary care physicians (PCPs) (study group) and inpatients managed by network PCPs (comparison group).


METHODS
Data before and after introduction of the hospitalist program were available. From the same period, data were available from patients of network PCPs who managed their own inpatient stays (nonhospitalist comparison sample). Three outcomes were used to represent inpatient utilization: (1) number of inpatient stays meeting ORG goals; (2) number of inpatient stays not meeting ORG goals that had > or =1 medically necessary days; and (3) number of inpatient stays not meeting ORG goals that had > or =1 medically unnecessary days.


RESULTS
Multiple logistic regression results indicated that inpatient stays were more likely to be within ORG utilization goals when managed by hospitalists vs nonhospitalists (P < .05). Introduction of the hospitalist program reduced the number of stays with unnecessary days among staff inpatients. There was an increase in stays with unnecessary days in the comparison group, ie, inpatients managed by network physicians.


CONCLUSIONS
Full-time hospitalists are efficient managers of HMO inpatients. The ORGs for acute, uncomplicated diagnoses provided useful hospital utilization measures that captured inpatient management by hospitalists and PCPs.
Molinari
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Eastern Washington State University, Cheney, WA 99004, USA. cmolinari@ewu.edu
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D000293:Adolescent; D000328:Adult; D000368:Aged; D006279:Health Maintenance Organizations; D020445:Hospitalists; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010821:Physicians, Family; D011320:Primary Health Care; D015397:Program Evaluation; D014481:United States; D014600:Utilization Review