Simmer T L, Nerenz D R, Rutt W M, Newcomb C S, Benfer D W
Department of Medicine, Henry Ford Hospital, Detroit, MI 48202.
Med Care. 1991 Jul;29(7 Suppl):JS31-40.
This study, a prospective, randomized trial comparing two inpatient staffing models, was undertaken to compare clinical and financial outcomes for general medicine inpatients assigned to resident (teaching) or staff (nonteaching) service. Key outcome measures included: 1) length of stay; 2) total charges; 3) laboratory, radiology, pharmacy, and supplies charges; 4) in-hospital mortality and mortality within 6 months of admission; and 5) 15-day readmission rate. The study took place at Henry Ford Hospital, a 937-bed urban teaching hospital in Detroit, Michigan; the subjects included all general internal medicine patients admitted to a single nursing unit of Henry Ford Hospital between October 1, 1987 and September 30, 1988. When the unit was fully staffed and operational, patients admitted to the Staff Service had a 1.7-day lower average length of stay than patients admitted to the Resident Service (P greater than 0.005), lower average total charges of $1,681 (P greater than 0.01), and significantly lower laboratory and pharmacy charges. No statistically significant differences in mortality rates or readmission rates were found. Even though personnel costs are invariably higher on an attending service, this staffing arrangement can be financially viable because of more efficient patterns of care. Shorter length of stay may be translated either into cost savings or increased revenues in order to offset higher salary costs. Teaching hospitals may wish to consider an attending service as one way to reduce house officer work loads, offer more opportunities for training in ambulatory settings, and adjust to a smaller pool of applicants for residency positions.
本研究是一项前瞻性随机试验，比较了两种住院人员配置模式，旨在比较分配到住院医师（教学）或 staff（非教学）服务的普通内科住院患者的临床和财务结果。主要结果指标包括：1）住院时间；2）总费用；3）实验室、放射科、药房和用品费用；4）住院死亡率和入院后 6 个月内的死亡率；5）15 天再入院率。该研究在密歇根州底特律市一家拥有 937 张床位的城市教学医院亨利福特医院进行；研究对象包括 1987 年 10 月 1 日至 1988 年 9 月 30 日期间入住亨利福特医院单个护理单元的所有普通内科患者。当该单元人员配备齐全并投入运营时，入住 Staff Service 的患者平均住院时间比入住 Resident Service 的患者短 1.7 天（P>0.005），平均总费用低 1681 美元（P>0.01），实验室和药房费用显著更低。在死亡率或再入院率方面未发现统计学上的显著差异。尽管主治医师服务的人员成本总是更高，但由于护理模式更高效，这种人员配置安排在财务上可能是可行的。较短的住院时间可以转化为成本节约或收入增加，以抵消更高的薪资成本。教学医院可能希望考虑采用主治医师服务作为减少住院医师工作量、提供更多门诊环境培训机会以及适应住院医师职位申请人数减少的一种方式。
