将通科医生引入医院：新加坡家庭医学驻院医师模式的效果。

Bringing generalists into the hospital: outcomes of a family medicine hospitalist model in Singapore.

机构信息

Family Medicine and Continuing Care, Singapore General Hospital, Singapore.

出版信息

J Hosp Med. 2011 Mar;6(3):115-21. doi: 10.1002/jhm.821.

DOI:10.1002/jhm.821

PMID:21387546

Abstract

PURPOSE

The aim of this study was to assess a newly introduced hospitalist care model in a Singapore hospital. Clinical outcomes of the family medicine hospitalists program were compared with the traditional specialists-based model using the hospital's administrative database.

METHODS

Retrospective cohort study of hospital discharge database for patients cared for by family medicine hospitalists and specialists in 2008. Multivariate analysis models were used to compare the clinical outcomes and resource utilization between patients cared for by family medicine hospitalists and specialist with adjustment for demographics, and comorbidities.

RESULTS

Of 3493 hospitalized patients in 2008 who met the criteria of the study, 601 patients were under the care of family medicine hospitalists. As compared with patients cared for by specialists, patients cared for by family medicine hospitalists had a shorter hospital length of stay (adjusted LOS, geometric mean, GM, 4.4 vs. 5.3 days; P < 0.001) and lower hospitalization costs (adjusted cost, GM, $2250.7 vs. $2500.0; P= 0.003), but a similar in-patient mortality rate (4.2% vs. 5.3%, P= 0.307) and 30-day all-cause unscheduled readmission rate (7.5% vs. 8.4%, P= 0.231) after adjustment for age, ethnicity, gender, intensive care unit (ICU) admission, numbers of organ failures, and comorbidities.

CONCLUSION

The family medicine hospitalist model was associated with reductions in hospital LOS and cost of care without adversely affecting mortality or 30-day all-cause readmission rate. These findings suggest that the hospitalist care model can be adapted for health systems outside North America and may produce similar beneficial effects in care efficiency and cost savings.

摘要

目的

本研究旨在评估新加坡一家医院新引入的医院医师照护模式。使用医院的行政数据库，比较家庭医学医院医师计划与传统专科医师模式的临床结果。

方法

对 2008 年家庭医学医院医师和专科医师照护的住院患者的医院出院数据库进行回顾性队列研究。使用多变量分析模型比较家庭医学医院医师和专科医师照护的患者的临床结果和资源利用情况，并进行了人口统计学和合并症的调整。

结果

在 2008 年符合研究标准的 3493 名住院患者中，有 601 名患者接受家庭医学医院医师的照护。与专科医师照护的患者相比，家庭医学医院医师照护的患者住院时间更短（调整后的 LOS，几何均数，GM，4.4 天 vs. 5.3 天；P<0.001），住院费用更低（调整后的费用，GM，2250.7 美元 vs. 2500.0 美元；P=0.003），但住院死亡率（4.2% vs. 5.3%，P=0.307）和 30 天全因非计划性再入院率（7.5% vs. 8.4%，P=0.231）相似，调整年龄、种族、性别、重症监护病房（ICU）入院、器官衰竭次数和合并症后。