PAs in hospital medicine: An expanded role or just more PAs?

The authors wanted to determine whether a higher than conventional PA-to-physician hospita-list staffing ratio could achieve similar clinical outcomes for inpatients at a community hospital. A retrospective cohort study compared hospitalist groups at a 384-bed community hospital. One group ("expanded PA") had a high PA-to-physician ratio model, with three physicians and three PAs; the PAs rounded on 14 patients a day (35.7% of all visits). The other group ("conventional") had a low PA-to-physician ratio model, with nine physicians and two PAs; the PAs rounded on nine patients a day (5.9% of all visits). For 16,964 adult patients discharged by the hospitalist groups with a medical principal APR-DRG code between 2012 and 2013, in-hospital mortality, cost of care, readmissions, length of stay (LOS), and consultant use were analyzed using logistic regression and adjusted for age, insurance status, severity of illness, and mortality risk. No statistically significant differences were found between the two groups for in-hospital mortality, readmissions, LOS (effect size 0.99 days shorter LOS in expanded PA group), or consultant use. Cost of care was less in the expanded PA group (effect size 3.52% less; estimated cost $2,644 versus $2,724). An expanded PA hospitalist-staffing model at a community hospital provided similar outcomes at a lower cost of care.