Subject(s)
Hospitalists , Physicians , Quality of Health Care , Humans , Hospitalists/classification , Hospitalists/economics , Hospitalists/standards , Length of Stay , Retrospective Studies , Osteopathic Physicians/economics , Osteopathic Physicians/standards , Physicians/economics , Physicians/standards , Quality of Health Care/economics , Quality of Health Care/standards , Hospitals/standards , Hospital CostsABSTRACT
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Subject(s)
Humans , Male , Female , Education/ethics , Education/organization & administration , Hospitals, Psychiatric/ethics , Hospitals, Psychiatric/organization & administration , Spain/ethnology , Hospitalists/education , Hospitalists/psychology , Forensic Medicine/education , Education/classification , Education/methods , Hospitals, Psychiatric/classification , Hospitals, Psychiatric/standards , Hospitalists/classification , Hospitalists/ethics , Forensic Medicine/methodsSubject(s)
Hospitalists/classification , Medicine , Obstetrics , Specialization , Female , Humans , Parturition , Pregnancy , United States , WorkforceABSTRACT
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.