Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
J Hosp Med. 2011 Mar;6(3):122-30. doi: 10.1002/jhm.826.
Residency reform in the form of work hour restrictions has forced academic medical centers to develop alternate models of care to provide inpatient care. One such model is the use of physician assistants (PAs) with hospitalists. However, these models of care have not been widely evaluated.
To compare the outcomes of inpatient care provided by a hospitalist-PA (H-PA) model with the traditional resident based model.
DESIGN, SETTING AND PATIENTS: We conducted a retrospective cohort study of 9681 general medical (GM) hospitalizations between January 2005 and December 2006 using a hospital administrative database. We used multivariable mixed models to adjust for a wide variety of potential confounders and account for multiple patient visits to the hospital to compare the outcomes of 2171 hospitalizations to H-PA teams with those of 7510 hospitalizations to resident teams (RES).
Length of stay (LOS), charges, readmission within 7, 14, and 30 days and inpatient mortality.
Inpatient care provided by H-PA teams was associated with a 6.73% longer LOS (P = 0.005) but charges, risk of readmission at 7, 14, and 30 days and inpatient mortality were similar to resident-based teams. The increase in LOS was dependent on the time of admission of the patients.
H-PA team-based GM inpatient care was associated with a higher LOS but similar charges, readmission rates, and inpatient mortality to traditional resident-based teams, a finding that persisted in sensitivity analyses.
以工时限制为形式的住院医师规范化培训改革迫使学术医疗中心开发替代的护理模式来提供住院患者的医疗服务。其中一种模式是使用医院医师助理（PAs）与医院医生（hospitalists）合作。然而，这些护理模式尚未得到广泛评估。
比较由医院医生-PA（H-PA）团队提供的住院患者医疗服务与传统住院医师主导模式的结果。
设计、地点和患者：我们使用医院管理数据库对 2005 年 1 月至 2006 年 12 月期间的 9681 例普通内科（GM）住院患者进行了回顾性队列研究。我们使用多变量混合模型调整了广泛的潜在混杂因素，并考虑了患者多次住院的情况，以比较 2171 例由 H-PA 团队提供的住院患者与 7510 例由住院医师团队（RES）提供的住院患者的结局。
住院时间（LOS）、费用、7、14 和 30 天内的再入院率以及住院内死亡率。
H-PA 团队提供的住院患者医疗服务与 LOS 延长 6.73%相关（P=0.005），但费用、7、14 和 30 天内的再入院风险以及住院内死亡率与住院医师团队相似。LOS 的增加取决于患者入院的时间。
H-PA 团队提供的 GM 住院患者医疗服务与 LOS 延长相关，但与传统住院医师团队相比，费用、再入院率和住院内死亡率相似，这一发现在敏感性分析中仍然存在。
