住院医师对农村医疗系统中成本、治疗结果及患者满意度的影响。

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

作者信息

Davis K M, Koch K E, Harvey J K, Wilson R, Englert J, Gerard P D

机构信息

North Mississippi Health Services, Tupelo, Mississippi, USA.

出版信息

Am J Med. 2000 Jun 1;108(8):621-6. doi: 10.1016/s0002-9343(00)00362-4.

DOI:10.1016/s0002-9343(00)00362-4

PMID:10856409

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.

摘要

目的

以往研究探讨了医院医师在城市学术医院中的作用。我们比较了一家拥有647张床位的农村社区医院中，由医院医师治疗的患者与由内科医师治疗的患者的治疗结果。

对象与方法

将医院医师治疗的10个最常见诊断相关组（DRG）中的443例患者，与1998财年由内科医师治疗的相同DRG中的1681例患者进行比较。比较了住院时间、护理费用、患者疾病严重程度、患者满意度、30天再入院率、住院死亡率、出院状态和资源利用情况。

结果

医院医师治疗的患者平均住院时间（±标准差）较短（4.1±3.0天对5.5±4.9天，P<0.001），护理费用低于内科医师治疗的患者（4098±2455美元对4658±4084美元，P<0.001）。对患者年龄、种族、性别、保险状况、疾病严重程度和特定医疗合并症进行校正后的分析证实了这些差异。医院医师和内科医师之间的差异在重病患者中最为明显。死亡率相似（医院医师为4.5%，内科医师为4.9%，P=0.80），再入院率也相似（医院医师为4.5%，内科医师为5.6%，P=0.41）。两组患者的满意度相似。内科医师在11个类别中的8个类别中使用了更多资源。