Palmer H C, Armistead N S, Elnicki D M, Halperin A K, Ogershok P R, Manivannan S, Hobbs G R, Evans K
Department of Medicine, West Virginia University, Morgantown, Pennsylvania, USA.
Am J Med. 2001 Dec 1;111(8):627-32. doi: 10.1016/s0002-9343(01)00976-7.
To evaluate the impact of implementing a hospitalist service with a nurse discharge planner in an academic teaching hospital.
Inpatient medicine service was provided by hospitalists, general internists, and specialists. Service personnel were identical except that the hospitalist service also had a nurse discharge planner. Hospitalists attended 4 months per year (compared with the 1 month by most other attending physicians) and had no outpatient responsibilities during the ward months. Patients were admitted alternately based on resident call schedule. Major outcomes included average costs of hospitalization, length of stay, and resource utilization. Quality measures included inpatient mortality, 30-day readmission rates, and satisfaction of patients, residents and students.
Hospitalist-attended services had lower mean (+/- SD) inpatient costs per patient ($4289 +/- $6512) compared with specialist-staffed services ($6066 +/- $7550, P < 0.0001), with a trend toward lower costs when compared with generalist-attended services ($4850 +/- $7027, P = 0.11). Hospitalist services had shorter mean lengths of stay (4.4 +/- 4.0 days), compared with generalists (5.2 +/- 5.2 days) and specialists (6.0 +/- 5.5 days, P < 0.0001 for hospitalists vs. both groups). Readmission rates were similar in all groups. Mortality rates were higher in the specialist group [5.0% (44 of 874)] compared with hospitalists [2.2% (18 of 829)] and generalists [2.6% (20 of 761), P = 0.002 for specialists vs. both groups, P = 0.09 for generalists vs hospitalists]. Satisfaction results were uniformly high in all groups, with no significant differences.
Hospitalist services with a nurse discharge planner were associated with lower average cost and shorter average length of hospital stay, without any apparent compromise in clinical outcomes or patient satisfaction.
评估在一所学术教学医院实施由护士出院计划员参与的住院医师服务的影响。
住院内科服务由住院医师、普通内科医生和专科医生提供。服务人员相同，只是住院医师服务还有一名护士出院计划员。住院医师每年出诊4个月（相比大多数其他主治医生的1个月），在病房工作月期间无门诊职责。患者根据住院医师值班安排交替入院。主要结局包括平均住院费用、住院时间和资源利用情况。质量指标包括住院死亡率、30天再入院率以及患者、住院医师和学生的满意度。
与专科医生提供服务的患者相比，由住院医师诊治的患者平均住院费用更低（4289美元±6512美元，专科医生诊治的患者为6066美元±7550美元，P<0.0001），与普通内科医生诊治的患者相比有费用降低的趋势（4850美元±7027美元，P = 0.11）。住院医师服务的平均住院时间更短（4.4天±4.0天），相比普通内科医生（5.2天±5.2天）和专科医生（6.0天±5.5天，住院医师与两组相比P<0.0001）。所有组的再入院率相似。专科医生组的死亡率更高[5.0%（874例中的44例）]，相比住院医师组[2.2%（829例中的18例）]和普通内科医生组[2.6%（761例中的20例），专科医生与两组相比P = 0.002，普通内科医生与住院医师相比P = 0.09]。所有组的满意度结果均普遍较高，无显著差异。
由护士出院计划员参与的住院医师服务与更低的平均费用和更短的平均住院时间相关，且在临床结局或患者满意度方面无任何明显折衷。
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