| Title | What effect does inpatient physician specialty and experience have on clinical outcomes and resource utilization on a general medical service? | | Author(s) | Parekh V, Saint S, Furney S, Kaufman S, McMahon L | | Institution | Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109-0376, USA. viparekh@umich.edu | | Source | J Gen Intern Med 2004 May; 19(5 Pt 1):395-401. | | MeSH | Academic Medical Centers
Comparative Study
Female
Hospital Costs
Hospitalists
Hospitalization
Humans
Internal Medicine
Length of Stay
Male
Medical Staff, Hospital
Michigan
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Care Team
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Retrospective Studies
Specialties, Medical
| | Abstract | OBJECTIVE: To examine the effects of internal medicine specialty and physician experience on inpatient resource use and clinical outcomes on an academic general medicine service.
DESIGN: A 1-year retrospective cohort study.
SETTING: The University of Michigan Hospitals, Ann Arbor, Michigan.
PATIENTS: Two thousand six hundred seventeen admissions to the general medicine service from July 2001 to June 2002, excluding those for whom data were incomplete (n = 18).
MEASUREMENTS AND MAIN RESULTS: Length of stay (LOS) and total hospital costs were used to measure resource utilization. Hospital mortality and 14-day and 30-day readmission rates were used to measure clinical outcomes. Adjusted mean LOS was significantly greater for rheumatologists (0.56 days greater; P =.002) and endocrinologists (0.38 days greater; P =.03) compared to general internists. Total costs were lower for general internists compared to endocrinologists ($1100 lower; P =.01) and rheumatologists ($431 lower; P =.07). Hospitalists showed a trend toward reduced LOS compared to all other physicians (0.31 days lower; P =.06). The top two deciles of physicians stratified by recent inpatient general medical experience showed significantly reduced LOS compared to all other physicians (0.35 days lower; P =.04). No significant differences were seen in readmission rates or in-hospital mortality among the various physician groups.
CONCLUSIONS: General internists had lower lengths of stay and costs compared to endocrinologists and rheumatologists. Hospitalists showed a trend toward reduced LOS compared to all other physicians. Recent inpatient general medicine experience appears to be a determinant of reduced inpatient resource use. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 15109336 |
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