title: Surgical Comanagement by Hospitalists Improves Patient Outcomes: A Propensity Score Analysis.
abstract: The aim of the study was to examine the impact of a surgical comanagement (SCM) hospitalist program on patient outcomes at an academic institution.
  
  
  
  Prior studies may have underestimated the impact of SCM due to methodological shortcomings.
  
  
  
  This is a retrospective study utilizing a propensity score-weighted intervention (n = 16,930) and control group (n = 3695). Patients were admitted between January 2009 to July 2012 (pre-SCM) and September 2012 to September 2013 (post-SCM) to Orthopedic or Neurosurgery at our institution. Using propensity score methods, linear regression, and a difference-in-difference approach, we estimated changes in outcomes between pre and post periods, while adjusting for confounding patient characteristics.
  
  
  
  The SCM intervention was associated with a significant differential decrease in the proportion of patients with at least 1 medical complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.74-0.96; P = 0.008), the proportion of patients with length of stay at least 5 days (OR 0.75; 95% CI, 0.67-0.84; P < 0.001), 30-day readmission rate for medical cause (OR 0.67; 95% CI, 0.52-0.81; P < 0.001), and the proportion of patients with at least 2 medical consultants (OR 0.55; 95% CI, 0.49-0.63; P < 0.001). There was no significant change in patient satisfaction (OR 1.08; 95% CI, 0.87-1.33; P = 0.507). We estimated average savings of $2642 to $4303 per patient in the post-SCM group. The overall provider satisfaction with SCM was 88.3%.
  
  
  
  The SCM intervention reduces medical complications, length of stay, 30-day readmissions, number of consultants, and cost of care.
authors.affiliation: *Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, CA†Department of Quality, Patient Safety, and Clinical Effectiveness, Stanford Health Care, CA.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Rohatgi
authors.forename: Pooja
authors.initials: P
authors.lastname: Loftus
authors.forename: Olgica
authors.initials: O
authors.lastname: Grujic
authors.forename: Mark
authors.initials: M
authors.lastname: Cullen
authors.forename: Joseph
authors.initials: J
authors.lastname: Hopkins
authors.forename: Neera
authors.initials: N
authors.lastname: Ahuja
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D065187:Controlled Before-After Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D057216:Propensity Score; D012017:Referral and Consultation; D012189:Retrospective Studies