 |
|
Hospital Care by Hospital-Based and Clinic-Based Faculty
A Prospective, Controlled Trial
Patrick J. Kearns, MD;
Clifford C. Wang, MD;
William J. Morris, MD;
Dennis G. Low, MD;
Allison S. Deacon, BS;
Stephanie Y. Chan, MD;
William A. Jensen, MD
Arch Intern Med. 2001;161:235-241.
Background The hospital length of stay decreases and clinical outcomes are maintained
when teaching hospitals involve hospital-based attending physicians in comparison
with traditional attending physicians. The attending physician's time commitment,
including the number of hours per day and months per year, required to achieve
this result is unknown. This study compared the clinical outcomes and cost
of care for patients treated by hospital-based and clinic-based attending
physicians devoting dramatically different amounts of time to supervising
residents on the medical wards of a suburban county hospital.
Methods Patients were alternately admitted to 2 groups of ward teams. Faculty
who attended 10 months of the year supervised one group. The comparison group's
attending physicians were on service for 2 months or less and maintained clinic
responsibilities while on service. The cost of patient care was compared by
means of the length of stay, total hospital costs, and costs for ancillary
services. Hospital mortality and readmission rates compared clinical outcomes.
Results There were 4456 patients hospitalized on the medical wards of a teaching
service. No differences were detected in the length of stay (4.37 ±
0.1 days for hospital-based and 4.39 ± 0.1 days for clinic-based attending
physicians). Hospital cost was observed to be similar (average cost, $5989
and $5977 per patient, respectively). The clinical outcomes were equivalent,
with adjusted mortality rates for hospital-based attending physicians of 3.2%
vs 3.9% for clinic-based attending physicians (P
= .28).
Conclusion An increase of faculty time and involvement for supervision of resident-managed
hospital care did not improve clinical outcomes or decrease costs during the
1-year study period.
From the Department of Medicine, Santa Clara Valley Medical Center,
San Jose, Calif.
Corresponding author and reprints: P. J. Kearns, MD, 751 Bascom Ave,
SCVMC, San Jose, CA 95128 (e-mail: pj.kearns{at}med.stanford.edu).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTER
Hospital Staff, Not Attending Physicians, Provide Continuity of Care
Mark G. Perlroth, Patrick Kearns, Clifford Wang, and Dennis Low
Arch Intern Med. 2001;161(21):2631-2632.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2001;161(2):301-302.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Growth in the Care of Older Patients by Hospitalists in the United States
Kuo et al.
NEJM 2009;360:1102-1112.
ABSTRACT
| FULL TEXT
Is Child Psychiatric Service Different When Provided by Attendings Versus Clinicians-in-Training?
Williams et al.
Acad. Psychiatry 2008;32:400-404.
ABSTRACT
| FULL TEXT
Les implications du phenomene des medecins hospitaliers
Lehmann et al.
cfp 2007;53:2131-2131.
ABSTRACT
| FULL TEXT
The Spectrum of Community-Based Hospitalist Practice: A Call to Tailor Internal Medicine Residency Training
Glasheen et al.
Arch Intern Med 2007;167:727-728.
FULL TEXT
An Alternative Approach to Reducing the Costs of Patient Care? A Controlled Trial of the Multi-Disciplinary Doctor-Nurse Practitioner (MDNP) Model
Ettner et al.
Med Decis Making 2006;26:9-17.
ABSTRACT
The Impact of Hospitalists on the Cost and Quality of Inpatient Care in the United States: A Research Synthesis
Coffman and Rundall
Med Care Res Rev 2005;62:379-406.
ABSTRACT
Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists
Meltzer et al.
ANN INTERN MED 2002;137:866-874.
ABSTRACT
| FULL TEXT
The Hospitalist Movement 5 Years Later
Wachter and Goldman
JAMA 2002;287:487-494.
ABSTRACT
| FULL TEXT
Hospital Staff, Not Attending Physicians, Provide Continuity of Care
Perlroth et al.
Arch Intern Med 2001;161:2631-2632.
FULL TEXT
|
