A pneumonia practice guideline and a hospitalist-based reorganization lead to equivalent efficiency gains.
OBJECTIVE
To compare the impact of a practice guideline for a common inpatient disorder with that of a hospitalist-based reorganization of an academic medical service.


METHODS
Retrospective cohort study.


METHODS
In July 1995 we introduced a clinical practice guideline for the treatment of community-acquired pneumonia at University of California San Francisco Moffitt-Long Hospital. Simultaneously, we implemented a structural change for half of the inpatient medical service, requiring earlier and more intensive faculty intervention, primarily by hospitalists. For 1 year, we studied the effect of these interventions on hospital costs, length of stay, and resource use.


RESULTS
As reported previously, the hospitalist-based intervention resulted in significant decreases in average adjusted cost ($7777 vs $7007, P = .05) and length of stay (4.9 days vs 4.3 days, P = .01) compared with both concurrent and historical controls. For patients with community-acquired pneumonia, a similar savings occurred when fiscal year 1996 was compared with fiscal year 1995 ($8164 vs $6282, P= .015; 5.0 vs 4.2 days, P= .04). However, the effect was identical for the hospitalist and nonhospitalist groups. The reduced length of stay was associated with a borderline significant reduction in readmission rates (from 4.8% to 0.7%, P = .055) and no change in mortality rates.


CONCLUSIONS
In this study, a hospitalist-based reorganization improved efficiency, with its greatest impact on the care of patients with disorders not covered by a practice guideline. The introduction of a guideline for a common diagnosis improved efficiency on both hospitalist- and nonhospitalist-based services. For common diagnoses amenable to practice guidelines, successful implementation of and compliance with guidelines may be an alternative to major organizational change.
Reddy
J C
JC
Department of Medicine, University of California San Francisco Medical Center, USA.
Katz
P P
PP
Goldman
L
L
Wachter
R M
RM
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000191:economics / Q000628:therapy*; D017598:Efficiency, Organizational; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006754:Hospital Restructuring; D020445:Hospitalists / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000191:economics / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012495:San Francisco