title: Comparison of hospital outcomes and resource use in acute COPD exacerbation patients managed by teaching versus nonteaching services in a community hospital.
abstract: OBJECTIVE
  The impact of teaching versus nonteaching services on outcomes and resource use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is unknown. The aim of the study is to evaluate the impact of an internal medicine teaching service compared to a nonteaching service on outcomes and resource use in patients admitted with AECOPD in a community teaching hospital.
  
  
  METHODS
  A retrospective cohort study of patients admitted for a primary diagnosis of chronic obstructive pulmonary disease exacerbation to Florida Hospital Orlando, a large community teaching hospital, between January 1, 2011, and December 31, 2014. Data were extracted from Premier administrative database. Risk adjusted length of stay (LOS), cost of hospitalization, 30-day readmissions, and mortality rate were measured. Risk adjustment for outcomes was based on Premier CareScience methodology.
  
  
  RESULTS
  A total of 1419 patients were included, 306 in the teaching group and 1113 in the nonteaching group. Risk adjusted cost and LOS were significantly lower in the teaching group compared to the nonteaching group (observed/expected cost 0.66 vs 1.06, P < .001) and (observed/expected LOS 0.93 vs 1.69, P < .001), respectively. No significant difference was found between the 2 groups in risk adjusted mortality and readmissions (P = .48 and .89, respectively). Use of consults was significantly lower in the teaching groups with 73% vs 31% of the patient in the teaching group had no consults compared to the nonteaching group (P < .001). The teaching service was significantly associated with decreased use of consults after adjustment for other variables (odds ratio, 0.17, 95% CI, 0.15-0.23, P < .001).
  
  
  CONCLUSIONS
  The teaching service had more favorable outcomes compared to nonteaching services in patients hospitalized for AECOPD. The physician practice model has a major impact on the cost, LOS, and use of consults in patients with AECOPD.
authors.affiliation: Florida Hospital Internal Medicine Residency Program, Orlando, FL, 32804, USA.
authors.forename: Khalid
authors.identifier: http://orcid.org/0000-0001-8842-7233
authors.initials: K
authors.lastname: Abusaada
authors.affiliation: Florida Hospital Internal Medicine Residency Program, Orlando, FL, 32804, USA.
authors.forename: Leen
authors.initials: L
authors.lastname: Alsaleh
authors.affiliation: Florida Hospital Internal Medicine Residency Program, Orlando, FL, 32804, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Herrera
authors.affiliation: Center for Value and Clinical Excellence (CVCE), Florida Hospital, Orlando, FL, 32802, USA.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Du
authors.affiliation: Florida Hospital Internal Medicine Residency Program, Orlando, FL, 32804, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Baig
authors.affiliation: Florida Hospital Internal Medicine Residency Program, Orlando, FL, 32804, USA.
authors.forename: George
authors.initials: G
authors.lastname: Everett
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D005431:Florida; D006305:Health Status Indicators; D017722:Hospital Charges / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors
keywords: chronic obstructive pulmonary disease; consultation; hospital Cos; hospital medicine; length of stay; resource use