Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system

Davis, Kenneth M; Koch, Karen E; Harvey, J.Ken; Wilson, Renee; Englert, Jan; Gerard, Patrick D

« Previous Next »The American Journal of Medicine
Volume 108, Issue 8 , Pages 621-626, June 2000

Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system

Kenneth M Davis, MD, MPH
- North Mississippi Health Services (KMD, KEK, JKH, RW, JE), Tupelo, Mississippi, USA
- Requests for reprints should be addressed to Kenneth M. Davis, MD, MPH, North Mississippi Health Services, 830 South Gloster Street, Tupelo, Mississippi 38801
Karen E Koch (PharmD)
- North Mississippi Health Services (KMD, KEK, JKH, RW, JE), Tupelo, Mississippi, USA
J.Ken Harvey, MD
- North Mississippi Health Services (KMD, KEK, JKH, RW, JE), Tupelo, Mississippi, USA
Renee Wilson, MD
- North Mississippi Health Services (KMD, KEK, JKH, RW, JE), Tupelo, Mississippi, USA
Jan Englert, RN
- North Mississippi Health Services (KMD, KEK, JKH, RW, JE), Tupelo, Mississippi, USA
Patrick D Gerard, PhD
- Experimental Statistics Unit (PDG), Mississippi State University, Starkville, Mississippi, USA

Received 9 August 1999; received in revised form 31 January 2000; accepted 31 January 2000. published online 16 August 2004.

Abstract

PURPOSE: Previous studies have examined the effects of hospitalists in urban academic hospitals. We compared the outcomes of patients treated by hospitalists with those of patients treated by internists at a 647-bed rural community hospital.

SUBJECTS AND METHODS: The 443 patients in the hospitalists’ 10 most common diagnosis-related groups (DRGs) were compared with 1,681 patients in the same DRGs who were cared for by internists in fiscal year 1998. Length of stay, cost of care, patient illness severity, patient satisfaction, 30-day readmission rate, inpatient mortality, discharge status, and resource utilization were compared.

RESULTS: The hospitalists’ patients had a shorter mean (± SD) length of stay (4.1 ± 3.0 days versus 5.5 ± 4.9 days, P <0.001) and their cost of care was less than that of the internists’ patients ($4,098 ± $2,455 versus $4,658 ± $4,084, P <0.001). Analyses that adjusted for patient age, race, sex, insurance status, severity of illness, and specific medical comorbidities confirmed these differences. The differences between hospitalists and internists were most apparent among very ill patients. Mortality rates were similar (4.5% for hospitalists versus 4.9% for internists, P = 0.80), as were the readmission rates (4.5% for hospitalists versus 5.6% for internists, P = 0.41). Patient satisfaction was similar for both groups. The internists used more resources in 8 of 11 categories.

CONCLUSIONS: The hospitalists provided cost-effective care, particularly for the sickest patients, with good outcomes and patient satisfaction.