A comparison of two hospitalist models with traditional care in a community teaching hospital.
OBJECTIVE
Many studies have documented significant length of stay reduction and cost savings when hospitalist care is compared with traditional care. However, less is known about the concurrent performance of more than one hospitalist model in a single site.


METHODS
This retrospective cohort study of 10595 patients was conducted between July 2001 and June 2002 in a tertiary care community-based teaching hospital. Risk-adjusted length of stay, variable costs, 30-day readmission rates, and in-hospital and 30-day mortality were measured for patients treated by Community Physicians, Private Hospitalists and Academic Hospitalists.


RESULTS
There was a 20% reduction in length of stay on the Academic Hospitalist service (p <.0001) and 8% on the Private Hospitalist service (P = .049) compared with Community Physicians. Similarly, total costs were 10% less on the Academic (P <.0001) and 6% less on the Private Hospitalist (P = .02) services compared with Community Physicians. The length of stay of Academic Hospitalists was 13% shorter than that of Private Hospitalists (P = .002); differences in costs between hospitalist groups were not statistically significant. Differences in in-hospital and 30-day mortality and 30-day readmission rates among the 3 physician groups were also not statistically significant.


CONCLUSIONS
The impact on patient outcomes and resource utilization may vary with the hospitalist model used. Future studies should examine the specific organizational characteristics of hospitalists that contribute to improved patient care and resource utilization.
Halasyamani
Lakshmi K
LK
Saint Joseph Mercy Hospital, Departments of Internal Medicine, Pathology, and the Quality Institute, Ann Arbor, MI 48197, USA. halasyal@trinity-health.org
Valenstein
Paul N
PN
Friedlander
Michael P
MP
Cowen
Mark E
ME
D000328:Adult; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D020445:Hospitalists; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017146:Models, Organizational; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D012189:Retrospective Studies