The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs.
OBJECTIVE
To compare nurse practitioner/physician management of hospital care, multidisciplinary team-based planning, expedited discharge, and assessment after discharge to usual management.


BACKGROUND
In the context of managed care, the goal of academic medical centers is to provide quality care at the lowest cost and minimize length of stay (LOS) while not compromising quality.


METHODS
Comparative, 2-group, quasiexperimental design was used; 1,207 general medicine patients (n=581 in the experimental group and n=626 in the control group) were enrolled. The control unit provided usual care. The care management in the experimental unit had 3 different components: an advanced practice nurse who followed the patients during hospitalization and 30 days after discharge, a hospitalist medical director and another hospitalist, and daily multidisciplinary rounds. LOS, hospital costs, mortality, and readmission 4 months after discharge were measured.


RESULTS
Average LOS was significantly lower for patients in the experimental group than the control group (5 vs. 6 days, P<.0001). The "backfill profit" to the hospital was US$1591 per patient in the experimental group (SE, US$639). There were no significant group differences in mortality or readmissions.


CONCLUSIONS
Collaborative physician/nurse practitioner multidisciplinary care management of hospitalized medical patients reduced LOS and improved hospital profit without altering readmissions or mortality.
Cowan
Marie J
MJ
School of Nursing, Hospitalist Division, VA Department of Medicine, UCLA Medical Center, University of California-Los Angeles, CA 90095-1702, USA. mcowan@sonnet.ucla.edu
Shapiro
Martin
M
Hays
Ron D
RD
Afifi
Abdelmonem
A
Vazirani
Sondra
S
Ward
Cathy Rodgers
CR
Ettner
Susan L
SL
D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs; D017052:Hospital Mortality; D020445:Hospitalists / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009722:Nurse Practitioners / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D010359:Patient Readmission; D019555:Physician-Nurse Relations; D024382:Professional Role; D012044:Regression Analysis; D014481:United States