What effect does inpatient physician specialty and experience have on clinical outcomes and resource utilization on a general medical service?
OBJECTIVE
To examine the effects of internal medicine specialty and physician experience on inpatient resource use and clinical outcomes on an academic general medicine service.


METHODS
A 1-year retrospective cohort study.


METHODS
The University of Michigan Hospitals, Ann Arbor, Michigan.


METHODS
Two thousand six hundred seventeen admissions to the general medicine service from July 2001 to June 2002, excluding those for whom data were incomplete (n = 18).


RESULTS
Length of stay (LOS) and total hospital costs were used to measure resource utilization. Hospital mortality and 14-day and 30-day readmission rates were used to measure clinical outcomes. Adjusted mean LOS was significantly greater for rheumatologists (0.56 days greater; P =.002) and endocrinologists (0.38 days greater; P =.03) compared to general internists. Total costs were lower for general internists compared to endocrinologists ($1100 lower; P =.01) and rheumatologists ($431 lower; P =.07). Hospitalists showed a trend toward reduced LOS compared to all other physicians (0.31 days lower; P =.06). The top two deciles of physicians stratified by recent inpatient general medical experience showed significantly reduced LOS compared to all other physicians (0.35 days lower; P =.04). No significant differences were seen in readmission rates or in-hospital mortality among the various physician groups.


CONCLUSIONS
General internists had lower lengths of stay and costs compared to endocrinologists and rheumatologists. Hospitalists showed a trend toward reduced LOS compared to all other physicians. Recent inpatient general medicine experience appears to be a determinant of reduced inpatient resource use.
Parekh
Vikas
V
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109-0376, USA. viparekh@umich.edu
Saint
Sanjay
S
Furney
Scott
S
Kaufman
Samuel
S
McMahon
Laurence
L
D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data*; D004470:Economics, Medical; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D020445:Hospitalists / Q000145:classification / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D007388:Internal Medicine / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital / Q000145:classification / Q000592:standards*; D008511:Medicine / Q000706:statistics & numerical data; D008824:Michigan; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D010348:Patient Care Team; D012189:Retrospective Studies; D013038:Specialization