Auerbach Andrew D, Wachter Robert M, Cheng H Quinny, Maselli Judith, McDermott Michael, Vittinghoff Eric, Berger Mitchel S
Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, CA 94143-0131, USA.
Arch Intern Med. 2010 Dec 13;170(22):2004-10. doi: 10.1001/archinternmed.2010.432.
Shared management of surgical patients between surgeons and hospitalists (comanagement) is increasingly common, yet few studies have described its effects.
Retrospective, interrupted time-series analysis of data collected from adults admitted to a neurosurgery service at our university-based teaching hospital between June 1, 2005, and December 31, 2008. Data regarding length of stay, costs, inpatient mortality rate, and 30-day readmission rate were collected from administrative sources; patient and caregiver satisfaction was assessed through surveys. We used multivariable models to estimate the effect of comanagement on key outcomes after adjusting for secular trends and patient-specific risk factors.
During the study period, 7596 patients were admitted to the neurosurgery service: 4203 (55.3%) before July 1, 2007, and 3393 (44.7%) after comanagement began. Of those admitted during the postimplementation period, 988 (29.1%) were comanaged. After implementation of comanagement, no differences were found in patient mortality rate, readmission, or length of stay. No consistent improvements were seen in patient satisfaction, but strong perceived improvements occurred in care quality reported by nurses and nonnurse health care professionals. In addition, we observed a reduction in hospital costs of $1439 per admission.
Implementation of a hospitalist comanagement service had little effect on patient outcomes or satisfaction but appeared to reduce hospital costs and improve health care professionals' perceptions of care quality. As comanagement models are adopted, more emphasis should be placed on developing systems that improve patient outcomes.
外科医生与住院医师共同管理手术患者（联合管理）的情况日益普遍，但很少有研究描述其效果。
对2005年6月1日至2008年12月31日期间在我校教学医院神经外科就诊的成年患者的数据进行回顾性中断时间序列分析。从行政来源收集住院时间、费用、住院死亡率和30天再入院率的数据；通过调查评估患者和护理人员的满意度。我们使用多变量模型在调整长期趋势和患者特定风险因素后估计联合管理对关键结局的影响。
在研究期间，7596名患者入住神经外科：2007年7月1日前有4203名（55.3%），联合管理开始后有3393名（44.7%）。在实施期入院的患者中，988名（29.1%）接受了联合管理。实施联合管理后，患者死亡率、再入院率或住院时间没有差异。患者满意度没有持续改善，但护士和非护士医护人员报告的护理质量有明显的感知改善。此外，我们观察到每次入院的医院成本降低了1439美元。
实施住院医师联合管理服务对患者结局或满意度影响不大，但似乎降低了医院成本并改善了医护人员对护理质量的看法。随着联合管理模式的采用，应更加重视开发改善患者结局的系统。
