| Title | Impact of a health maintenance organization hospitalist system in academic pediatrics. | | Author(s) | Landrigan CP, Srivastava R, Muret-Wagstaff S, Soumerai SB, Ross-Degnan D, Graef JW, Homer CJ, Goldmann DA | | Institution | Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. landrigan_c@hub.tch.harvard.edu | | Source | Pediatrics 2002 Oct; 110(4):720-8. | | MeSH | Adolescent
Attitude to Health
Child
Child, Preschool
Comparative Study
Female
Follow-Up Studies
Health Care Costs
Health Maintenance Organizations
Health Services Research
Hospital Mortality
Hospitalists
Hospitals, Pediatric
Hospitals, Teaching
Humans
Length of Stay
Male
Parents
Patient Readmission
Pediatrics
Quality of Health Care
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
| | Abstract | OBJECTIVE: Hospitalist systems decrease length of stay (LOS) and cost for hospitalized adults. Whether hospitalist systems decrease LOS and cost for hospitalized children has not been conclusively established. We wanted to determine whether a health maintenance organization's (HMO's) implementation of a pediatric hospitalist system affected LOS, costs, mortality, readmission rate, follow-up rate, and parents' ratings of care.
DESIGN: Interrupted time-series study of general pediatric patients admitted to a freestanding pediatric teaching hospital from 1993 to 1998. The intervention group consisted of all patients admitted to a staff model not-for-profit HMO that began using hospitalists in October 1996. Patients in other HMOs and traditional insurance groups were studied for comparison. The main outcomes were mean LOS and inflation-adjusted costs. Other outcomes included parents' ratings of care and mortality, readmission, and follow-up rates.
RESULTS: Immediately after the introduction of the hospitalist system, mean LOS for staff model not-for-profit HMO fell 12% (0.3 days), and mean cost of hospitalization decreased 16% ($217) compared with prehospitalist levels. Parental ratings of care, initially somewhat low, improved substantially. Seven-day follow-up rates, mortality, and readmission rates did not change. Comparison groups experienced no concurrent improvements in LOS, cost, parental ratings, mortality, or readmission rates.
CONCLUSIONS: A pediatric hospitalist system within a staff-model HMO significantly improved LOS, cost, and parental ratings of care without affecting rates of posthospitalization follow-up. Additional studies are needed both to measure broader aspects of quality and to assess the impact of such a program on patients being cared for through other types of delivery and insurance systems. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 12359785 |
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