Chin David L, Wilson Michelle H, Bang Heejung, Romano Patrick S
Center for Healthcare Policy and Research, University of California Davis, 2103 Stockton Blvd., Sacramento, CA, 95817, USA,
J Gen Intern Med. 2014 Dec;29(12):1672-8. doi: 10.1007/s11606-014-2982-y.
Patient outcomes with hospitalist care have been studied in many settings, yet little is known about how hospitalist care interacts with trainee care to affect patient outcomes in teaching hospitals.
The aim of this study was to compare patient outcomes between hospitalist-preceptors and hospitalists working alone (isolating the effect of housestaff involvement), and between hospitalist-preceptors and academician-preceptors (isolating the effect of attending type, given housestaff involvement).
A four-year retrospective cohort study of patients (n = 13,313) admitted to all internal medicine services at an academic medical center from July 2008 to June 2012.
Using generalized estimating equations, we measured readmission within 30 days, hospital length of stay, cost of the index hospitalization, and cumulative cost including readmissions within 30 days.
In the adjusted models, 30-day readmission odds were higher for academic-preceptors (OR, 1.14 [95% CI, 1.03 - 1.26]) and hospitalist-preceptors (OR, 1.10 [95% CI, 1.002 - 1.21]) than for hospitalists working alone. Compared with hospitalists working alone, academic-preceptors were associated with shorter length of stay (mean difference, 0.27 days [95% CI, 0.18 - 0.38]), lower index hospitalization costs (mean difference, $386 [95% CI, $192 - $576]), but similar cumulative inpatient costs within 30 days of discharge. Compared with hospitalists working alone, hospitalist-preceptors were associated with shorter length of stay (mean difference, 0.34 days [95% CI, 0.26 - 0.42]), lower index hospitalization cost (mean difference, $570 [95% CI, $378 - $760]), and a trend toward lower cumulative cost (mean difference, $1347 [95% CI, $254 - $2,816]).
Preceptor-led medicine services were associated with more readmissions within 30 days, shorter lengths of stay, and lower index admission-associated costs. However, when considering cumulative hospitalization costs, patients discharged by academician-preceptors incurred the highest cost and hospitalist-preceptors incurred the lowest cost.
在许多环境中都对住院医师护理的患者结局进行了研究，但对于教学医院中住院医师护理与实习医生护理如何相互作用以影响患者结局却知之甚少。
本研究的目的是比较由住院医师带教的实习医生与单独工作的住院医师之间的患者结局（分离住院医师参与的影响），以及由住院医师带教的实习医生与由专科医生带教的实习医生之间的患者结局（在有住院医师参与的情况下，分离主治医生类型的影响）。
对2008年7月至2012年6月期间在一所学术医疗中心所有内科服务科室收治的患者（n = 13313）进行为期四年的回顾性队列研究。
使用广义估计方程，我们测量了30天内的再入院情况、住院时间、首次住院费用以及包括30天内再入院的累计费用。
在调整模型中，由专科医生带教的实习医生（比值比，1.14 [95%可信区间，1.03 - 1.26]）和由住院医师带教的实习医生（比值比，1.10 [95%可信区间，1.002 - 1.21]）的30天再入院几率高于单独工作的住院医师。与单独工作的住院医师相比，由专科医生带教的实习医生住院时间较短（平均差异，0.27天 [95%可信区间，0.18 - 0.38]），首次住院费用较低（平均差异，386美元 [95%可信区间，192美元 - 576美元]），但出院后30天内的累计住院费用相似。与单独工作的住院医师相比，由住院医师带教的实习医生住院时间较短（平均差异，0.34天 [95%可信区间，0.26 - 0.42]），首次住院费用较低（平均差异，570美元 [95%可信区间，378美元 - 760美元]），且有累计费用较低的趋势（平均差异，1347美元 [95%可信区间，254美元 - 2816美元]）。
由带教医生主导的内科服务与30天内更多的再入院、较短的住院时间以及较低的首次入院相关费用有关。然而，在考虑累计住院费用时，由专科医生带教的实习医生负责出院的患者费用最高，由住院医师带教的实习医生负责出院的患者费用最低。
