Jose A Perez1, Melina Awar, Aryan Nezamabadi, Richard Ogunti, Mamta Puppala, Lara Colton, Johanna M Clewing, Sayali Ketkar, Stephen T C Wong, Richard J Robbins. 1. J.A. Perez Jr is professor of clinical medicine, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. M. Awar is assistant professor of clinical medicine, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. A. Nezamabadi is a hospitalist, Salinas Valley Healthcare System, Salinas, California. At the time of the study, the author was a third-year internal medicine resident, Houston Methodist Hospital, Houston, Texas. R. Ogunti is a first-year resident, Internal Medicine, Howard University, Washington, DC. At the time of the study, the author was a project specialist, Department of Systems Medicine and Bioengineering, Houston Methodist Hospital, Houston, Texas. M. Puppala is a senior applications analyst, Department of Systems Medicine and Bioengineering, Houston Methodist Hospital, Houston, Texas. L. Colton is assistant professor of clinical medicine, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. J.M. Clewing is assistant professor of clinical medicine, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. S. Ketkar is clinical quality analytics/integration manager, Houston Methodist Hospital, Houston, Texas. S.T.C. Wong is professor and chair, Department of Systems Medicine and Bioengineering, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. R.J. Robbins is professor and chair, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas.
Abstract
PURPOSE: To compare costs of care and quality outcomes between teaching and nonteaching hospitalist services, while testing the assumption that resident-driven care is more expensive. METHOD: Records of inpatients with the top 20 Medicare Severity Diagnosis-Related Groups admitted to the University Teaching Service (UTS) and nonteaching hospitalist service (NTHS) at Houston Methodist Hospital from 2014-2015 were analyzed retrospectively. Direct costs of care, length of stay (LOS), in-hospital mortality (IHM), 30-day readmission rate (30DRR), and consultant utilization were compared between the UTS and NTHS. Propensity score matching and case mix index (CMI) were used to mitigate differences in baseline characteristics. To compare outcomes between matched groups, the Wilcoxon rank sum test and chi-square test were used. A sensitivity analysis was conducted using multivariable regression analysis. RESULTS: From the overall study population of 8,457 patients, 1,041 UTS and 3,123 NTHS patients were matched. CMI was 1.07 for each group. The UTS had lower direct costs of care per case ($5,028 vs. $5,502, P = .006), lower LOS (4.7 vs. 5.2 days, P = .0002), and lower consultant utilization (1.0 vs. 1.6, P ≤ .0001) versus the NTHS. The UTS and NTHS 30DRR (17.2% vs. 19.3%, P = .110) and IHM (2.9% vs. 3.7%, P = .206) were comparable. The multivariable regression analysis validated the matched data and identified an incremental cost savings of $333/UTS patient. CONCLUSIONS: Patients of an academic hospitalist service had significantly shorter LOS, fewer consultants, and lower direct care costs than comparable patients of a nonteaching service.
PURPOSE: To compare costs of care and quality outcomes between teaching and nonteaching hospitalist services, while testing the assumption that resident-driven care is more expensive. METHOD: Records of inpatients with the top 20 Medicare Severity Diagnosis-Related Groups admitted to the University Teaching Service (UTS) and nonteaching hospitalist service (NTHS) at Houston Methodist Hospital from 2014-2015 were analyzed retrospectively. Direct costs of care, length of stay (LOS), in-hospital mortality (IHM), 30-day readmission rate (30DRR), and consultant utilization were compared between the UTS and NTHS. Propensity score matching and case mix index (CMI) were used to mitigate differences in baseline characteristics. To compare outcomes between matched groups, the Wilcoxon rank sum test and chi-square test were used. A sensitivity analysis was conducted using multivariable regression analysis. RESULTS: From the overall study population of 8,457 patients, 1,041 UTS and 3,123 NTHS patients were matched. CMI was 1.07 for each group. The UTS had lower direct costs of care per case ($5,028 vs. $5,502, P = .006), lower LOS (4.7 vs. 5.2 days, P = .0002), and lower consultant utilization (1.0 vs. 1.6, P ≤ .0001) versus the NTHS. The UTS and NTHS 30DRR (17.2% vs. 19.3%, P = .110) and IHM (2.9% vs. 3.7%, P = .206) were comparable. The multivariable regression analysis validated the matched data and identified an incremental cost savings of $333/UTS patient. CONCLUSIONS:Patients of an academic hospitalist service had significantly shorter LOS, fewer consultants, and lower direct care costs than comparable patients of a nonteaching service.
Authors: Moaath K Mustafa Ali; Marwa M Sabha; Sarah K Mustafa; Momen Banifadel; Sami Ghazaleh; Kanana M Aburayyan; Marcel T Ghanim; Mohammed T Awad; Damynus N Gekonde; Amala R Ambati; Ahmad Ramahi; Ahmed M Elzanaty; Zeid Nesheiwat; Pinang M Shastri; Mohammad Al-Sarie; John McGready Journal: J Gen Intern Med Date: 2021-01-25 Impact factor: 5.128