All Entries Tagged With: "length of stay"
Hospitalists are efficient diagnosticians, study says
We've known for years that hospitalist care cuts down on length of stay, but what about diagnostics and throughput?
Patients under hospitalist care, particularly intensivist care, experienced shorter length of stay and reduction in testing than teaching teams, according to a new study, “Determinants of Hospitalist Efficiency: A Qualitative and Quantitative Study,” published in the June issue of Medical Care Research and Review. Researchers also found that hospitalists are efficient diagnosticians and enhance throughput.
Although the study demonstrated the benefits hospitalists provide, it also showed little evidence that they are more focused on quality or use community resources better than non-hospitalist providers.
Do you know of any new studies that evaulate hospitalist care on overall patient quality and hospital revenue?
Finding the holy grail of paying for health
A friend of mine, who is one of the top hospital consultants in the country, asked me for advice on a problem posed by one of his clients. They wanted to find a more effective way to run the incentivize program for their hospitalists, such that the doctors would be collectivized to take on difficult cases but treat them expeditiously. The program director had a formula involving DRG severity weights divided by LOS, which is an interesting idea, but probably would not work well unless a single physician treated each patient without handoffs.
It led me back to a problem that I have pondered for more than twenty years—how do we measure the work product of physicians? We know very well how to pay for generating charge tickets, hours worked, and panel sizes, but none of these get at the fundamental problem. How do we measure the health that a doctor produces? This should not be confused with process measures like giving aspirin to MI patients.
Continuity of care decreases at end of life, new study says
During the 1990s and early 2000s, continuity of care from home to hospital declined, according to a new study by The University of Texas in Galveston.
Researchers found that in terminal patients with advanced lung cancer (stage IIIB or IV) between 1992 and 2002, outpatient-to-inpatient continuity of care dropped from 60% to 51%. In addition, these patients were less likely to spend time in the ICU before death. [more]
Hospitalists coordinate communication, cut costs, and reduce LOS, new study says
The hospitalist model produces better patient outcomes, according to a study, "Is the doctor in? A relational approach to job design and the coordination of work," published in winter 2008 issue of Human Resource Management.
As the first research to link job design (education, consulting, healthcare) to outcomes, the study evaluated the effects of stage and site-based physician specialization on coordination and performance outcomes, according to the abstract.
Studying more than 6,000 cases at the Newton-Wellesley Hospital, MA during July 2001 to July 2003, researchers found that the hospitalist model was linked to the following results:
- Reduced length of stay by about half a day
- Cut hospital costs by $655 per patient
- Reduced the risk of readmission by nearly 42%
- Improved coordination of communication between physicians and other care providers by more than 13%
Hospitalist service and house staff service produce equivalent outcomes
In academic centers, two types of services offer a similar quality and efficiency of patient care: (1) traditional house staff services and (2) services with physician assistants, supervised by hospitalists, according to a new study by Brigham & Women’s Hospital in Boston, called “Implementation of a physician assistant/hospitalist service in an academic medical center: Impact on efficiency and patient outcomes,” published in the October issue of the Journal of Hospital Medicine.
In a survey of nearly 5,200 patients admitted to a general medical service between July 2005 and June 2006, researchers found that patient outcome measures were not significantly different between these two types of services. Length of stay, inpatient mortality, ICU transfers, readmissions, and patient satisfaction were effectively the same.
“For general medicine inpatients admitted to an academic medical center, a service staffed by hospitalists and physician assistants can provide a safe alternative to house staff services, with comparable efficiency,” researchers of the study concluded in the abstract.
Pediatric hospitalist care cuts costs and LOS, study says
A staff-only general pediatric hospitalist service can decrease costs and reduce length of stay when compared to a traditional faculty and house staff subspecialty service, according to a new study. The study, “Staff-only pediatric hospitalist care of patients with medically complex subspecialty conditions in a major teaching hospital,” published in the October issue of Archives of Pediatrics & Adolescent Medicine, evaluated 925 pediatric patients with medically complex subspecialty diseases (gastroenterology and hematology/oncology) in 2005 and 2006.
When the faculty and house staff reached their maximum patient census, they turned over the remaining patients to the hospitalist team. The study found that patient length of stay in the hospitalist service totaled an average of 7.2 days, compared to 9.8 days during the non-hospitalist service. Patient costs on the hospitalist service averaged $11,000 versus the higher costs of $16,500 on the non-hospitalist service.
Researchers concluded, “In this era of resident duty-hour restrictions and medical complexity of conditions in inpatients, staff-only hospitalist programs may have a vital role in pediatric teaching hospitals.”
