title: Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study.
abstract: BACKGROUND
  Hospitalist care has grown rapidly, in part because it is associated with decreased length of stay and hospital costs. No national studies examining the effect of hospitalist care on hospital costs or on medical utilization and costs after discharge have been done.
  
  
  OBJECTIVE
  To assess the relationship of hospitalist care with hospital length of stay, hospital charges, and medical utilization and Medicare costs after discharge.
  
  
  METHODS
  Population-based national cohort study.
  
  
  METHODS
  Hospital care of Medicare patients.
  
  
  METHODS
  A 5% national sample of enrollees in Medicare parts A and B with a primary care physician who were cared for by their primary care physician or a hospitalist during medical hospitalizations from 2001 to 2006.
  
  
  METHODS
  Length of stay, hospital charges, discharge location and physician visits, emergency department visits, rehospitalization, and Medicare spending within 30 days after discharge.
  
  
  RESULTS
  In propensity score analysis, hospital length of stay was 0.64 day less among patients receiving hospitalist care. Hospital charges were $282 lower, whereas Medicare costs in the 30 days after discharge were $332 higher (P < 0.001 for both). Patients cared for by hospitalists were less likely to be discharged to home (odds ratio, 0.82 [95% CI, 0.78 to 0.86]) and were more likely to have emergency department visits (odds ratio, 1.18 [CI, 1.12 to 1.24]) and readmissions (odds ratio, 1.08 [CI, 1.02 to 1.14]) after discharge. They also had fewer visits with their primary care physician and more nursing facility visits after discharge.
  
  
  CONCLUSIONS
  Observational studies are subject to selection bias.
  
  
  CONCLUSIONS
  Decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.
  
  
  BACKGROUND
  National Institute on Aging and National Cancer Institute.
authors.affiliation: Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas 77555-0177, USA. yokuo@utmb.edu
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
mesh_terms: D003266:Continuity of Patient Care; D003361:Cost Allocation; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs; D020445:Hospitalists / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D057216:Propensity Score; D014481:United States