Associations with reduced length of stay and costs on an academic hospitalist service

Background: Prior studies of hospitalist services have suggested improved efficiency and quality of care compared with traditional inpatient services. Objectives: To compare outcomes of patients on a new hospitalist service with those on traditional inpatient services and to determine the impact of hospitalists on particular patient subgroups. Study Design: Prospective, quasiexperimental, observational. Methods: The study was conducted on the general medicine service at an academic teaching hospital, staffed by hospitalist physicians (HP) and nonhospitalist physicians (NHP), and included 1706 consecutive, directly admitted patients over I year. Results: The 447 HP patients and 1259 NHP patients had similar rates of in-hospital mortality (1.3% vs 2.1%, respectively; P = .29) and 30-day readmission (7.8% vs 8.7%, respectively; P = .55). Mean hospital length of stay (LOS) was I day shorter for HP patients in unadjusted analyses (5.5 vs 6.5 days, respectively; P = .009) and in multivariable analyses adjusting for clustering and patient factors. Physician experience was not correlated (P < .2) with LOS., In stratified analyses, differences in LOS between HP and NHP patients were greater for patients residing closer to the hospital. Mean total costs were $917 less for HP patients (P = .08) and 10% less(P = .04) in multivariable analyses. Decreases in costs were significant (P < .05) for nursing ($604; P = .002) and laboratory services ($126; P = .04). Nonetheless, mean costs per day were $122 higher (P = .003) for HP patients. Conclusions: Patients managed by hospitalists had shorter LOS and lower costs than patients managed by nonhospitalists, but had higher costs per day. These results suggest that hospitalists increase the intensity of care and may have their greatest impact on specific types of patients and classes of hospital costs.