title: Comanagement of surgical patients between neurosurgeons and hospitalists.
abstract: BACKGROUND
  Shared management of surgical patients between surgeons and hospitalists (comanagement) is increasingly common, yet few studies have described its effects.
  
  
  METHODS
  Retrospective, interrupted time-series analysis of data collected from adults admitted to a neurosurgery service at our university-based teaching hospital between June 1, 2005, and December 31, 2008. Data regarding length of stay, costs, inpatient mortality rate, and 30-day readmission rate were collected from administrative sources; patient and caregiver satisfaction was assessed through surveys. We used multivariable models to estimate the effect of comanagement on key outcomes after adjusting for secular trends and patient-specific risk factors.
  
  
  RESULTS
  During the study period, 7596 patients were admitted to the neurosurgery service: 4203 (55.3%) before July 1, 2007, and 3393 (44.7%) after comanagement began. Of those admitted during the postimplementation period, 988 (29.1%) were comanaged. After implementation of comanagement, no differences were found in patient mortality rate, readmission, or length of stay. No consistent improvements were seen in patient satisfaction, but strong perceived improvements occurred in care quality reported by nurses and nonnurse health care professionals. In addition, we observed a reduction in hospital costs of $1439 per admission.
  
  
  CONCLUSIONS
  Implementation of a hospitalist comanagement service had little effect on patient outcomes or satisfaction but appeared to reduce hospital costs and improve health care professionals' perceptions of care quality. As comanagement models are adopted, more emphasis should be placed on developing systems that improve patient outcomes.
authors.affiliation: Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, CA 94143-0131, USA. ada@medicine.ucsf.edu
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Auerbach
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wachter
authors.forename: H Quinny
authors.initials: HQ
authors.lastname: Cheng
authors.forename: Judith
authors.initials: J
authors.lastname: Maselli
authors.forename: Michael
authors.initials: M
authors.lastname: McDermott
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D005260:Female; D018166:Health Care Reform; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D020445:Hospitalists / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007297:Inpatients; D007388:Internal Medicine / Q000191:economics / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009493:Neurosurgery / Q000191:economics / Q000458:organization & administration*; D019635:Neurosurgical Procedures / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D012495:San Francisco; D013503:Surgery Department, Hospital / Q000191:economics / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome