title: The Effects of a Hospitalist Comanagement Model for Joint Arthroplasty Patients in a Teaching Facility.
abstract: BACKGROUND
  The goal of this study was to compare postoperative medical comanagement of total hip arthroplasty and total knee arthroplasty patients using a hospitalist (H) and nonhospitalist (NH) model at a single teaching institution to determine the clinical and economic impact of the hospitalist comanagement.
  
  
  METHODS
  We retrospectively reviewed the records of 1656 patients who received hospitalist comanagement with 1319 patients who did not. The NH and H cohorts were compared at baseline via chi-square test for the American Society of Anesthesiologists classification, the t test for age, and the Wilcoxon test for the unadjusted Charlson Comorbidity Index score and the age-adjusted Charlson Comorbidity Index score. Chi-square test was used to compare the postoperative length of stay, readmission rate at 30 days after surgery, diagnoses present on admission, new diagnoses during admission, tests ordered postoperatively, total direct cost, and discharge location.
  
  
  RESULTS
  The H cohort gained more new diagnoses (P < .001), had more studies ordered (P < .001), had a higher cost of hospitalization (P = .002), and were more likely to be discharged to a skilled nursing facility (P < .001). The H cohort also had a lower length of stay (P < .001), but we believe evolving techniques in both pain control and blood management likely influenced this. There was no significant difference in readmissions.
  
  
  CONCLUSIONS
  Any potential benefit of a hospitalist comanagement model for this patient population may be outweighed by increased cost.
authors.affiliation: Department of Orthopaedic Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Neil L
authors.initials: NL
authors.lastname: Duplantier
authors.affiliation: Department of Orthopaedic Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: David C
authors.initials: DC
authors.lastname: Briski
authors.affiliation: Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana.
authors.forename: Lindsay T
authors.initials: LT
authors.lastname: Luce
authors.affiliation: Department of Orthopaedic Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana; Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Meyer
authors.affiliation: Department of Orthopaedic Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana; Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana.
authors.forename: John L
authors.initials: JL
authors.lastname: Ochsner
authors.affiliation: Department of Orthopaedic Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana; Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana.
authors.forename: George F
authors.initials: GF
authors.lastname: Chimento
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D020445:Hospitalists / Q000191:economics* / Q000458:organization & administration*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000191:economics*; D010351:Patient Discharge; D010359:Patient Readmission; D012189:Retrospective Studies; D000078329:Workforce
keywords: arthroplasty; cost; hip; hospitalist; knee; risk adjustment