Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.
Med Care. 2011 Aug;49(8):701-7. doi: 10.1097/MLR.0b013e3182166cb6.
The use of hospitalists is increasing. Hospitalists have been associated with reductions in length of stay and associated costs while not negatively impacting outcomes. We examine care for stroke patients because it requires complex care in the hospital and has high post discharge complications. We assessed the association of care provided by a hospitalist with length of stay, discharge destination, 30-day mortality, 30-day readmission, and 30-day emergency department visits.
This study used the 5% Medicare sample from 2002 to 2006. Models included demographic variables, prior health status, type of admission and hospital, and region. Multinomial logit models, generalized estimating equations, Cox proportional hazard models, and propensity score analyses were explored in the analysis.
After adjusting models for covariates, hospitalists were associated with increased odds of discharge to inpatient rehabilitation or other facilities compared with discharge home (Odds Ratio, 1.24; 95% CI, 1.07-1.43 and Odds Ratio, 1.34; 95% CI 1.05-1.69, respectively). Mean length of stay was 0.37 days lower for patients in hospitalist care compared to nonhospitalist care. This reduction in length of stay was not appreciably changed after adjusting for discharge destination. Hospitalist care was not associated with differences in 30-day emergency department use or mortality. Readmission rates were higher for patients in hospitalist care (Hazard, 1.30; 95% CI, 1.11-1.52).
Hospitalists are associated with reduced length of stay and higher rates of discharge to inpatient rehabilitation. The higher readmission rates should be further explored.
越来越多的医院医生被采用。医院医生的使用与住院时间和相关成本的减少有关，同时不会对结果产生负面影响。我们研究了中风患者的护理，因为它需要在医院进行复杂的护理，并且有很高的出院后并发症。我们评估了医院医生提供的护理与住院时间、出院去向、30 天死亡率、30 天再入院率和 30 天急诊就诊之间的关联。
本研究使用了 2002 年至 2006 年的 Medicare 5%抽样数据。模型包括人口统计学变量、既往健康状况、入院类型和医院以及地区。在分析中探讨了多项逻辑回归模型、广义估计方程、Cox 比例风险模型和倾向评分分析。
在调整了协变量的模型中，与出院回家相比，医院医生与更高的几率被送往住院康复或其他设施出院相关（优势比，1.24；95%置信区间，1.07-1.43 和优势比，1.34；95%置信区间，1.05-1.69）。与非医院医生护理相比，接受医院医生护理的患者的平均住院时间缩短了 0.37 天。在调整出院去向后，这种住院时间的缩短并没有明显改变。医院医生护理与 30 天内急诊就诊或死亡率无差异。接受医院医生护理的患者再入院率更高（风险比，1.30；95%置信区间，1.11-1.52）。
医院医生与缩短住院时间和提高住院康复出院率有关。更高的再入院率应进一步探讨。
