A comparison of two hospitalist models with traditional care in a community teaching hospital.

Purpose: Many studies have documented significant length of stay reduction and cost savings when hospitalist care is compared with traditional care. However, less is known about the concurrent performance of more than one hospitalist model in a single site.

Subjects And Methods: This retrospective cohort study of 10595 patients was conducted between July 2001 and June 2002 in a tertiary care community-based teaching hospital. Risk-adjusted length of stay, variable costs, 30-day readmission rates, and in-hospital and 30-day mortality were measured for patients treated by Community Physicians, Private Hospitalists and Academic Hospitalists.

Results: There was a 20% reduction in length of stay on the Academic Hospitalist service (p <.0001) and 8% on the Private Hospitalist service (P = .049) compared with Community Physicians. Similarly, total costs were 10% less on the Academic (P <.0001) and 6% less on the Private Hospitalist (P = .02) services compared with Community Physicians. The length of stay of Academic Hospitalists was 13% shorter than that of Private Hospitalists (P = .002); differences in costs between hospitalist groups were not statistically significant. Differences in in-hospital and 30-day mortality and 30-day readmission rates among the 3 physician groups were also not statistically significant.

Conclusions: The impact on patient outcomes and resource utilization may vary with the hospitalist model used. Future studies should examine the specific organizational characteristics of hospitalists that contribute to improved patient care and resource utilization.