Rohatgi Nidhi, Loftus Pooja, Grujic Olgica, Cullen Mark, Hopkins Joseph, Ahuja Neera
*Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, CA†Department of Quality, Patient Safety, and Clinical Effectiveness, Stanford Health Care, CA.
Ann Surg. 2016 Aug;264(2):275-82. doi: 10.1097/SLA.0000000000001629.
The aim of the study was to examine the impact of a surgical comanagement (SCM) hospitalist program on patient outcomes at an academic institution.
Prior studies may have underestimated the impact of SCM due to methodological shortcomings.
This is a retrospective study utilizing a propensity score-weighted intervention (n = 16,930) and control group (n = 3695). Patients were admitted between January 2009 to July 2012 (pre-SCM) and September 2012 to September 2013 (post-SCM) to Orthopedic or Neurosurgery at our institution. Using propensity score methods, linear regression, and a difference-in-difference approach, we estimated changes in outcomes between pre and post periods, while adjusting for confounding patient characteristics.
The SCM intervention was associated with a significant differential decrease in the proportion of patients with at least 1 medical complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.74-0.96; P = 0.008), the proportion of patients with length of stay at least 5 days (OR 0.75; 95% CI, 0.67-0.84; P < 0.001), 30-day readmission rate for medical cause (OR 0.67; 95% CI, 0.52-0.81; P < 0.001), and the proportion of patients with at least 2 medical consultants (OR 0.55; 95% CI, 0.49-0.63; P < 0.001). There was no significant change in patient satisfaction (OR 1.08; 95% CI, 0.87-1.33; P = 0.507). We estimated average savings of $2642 to $4303 per patient in the post-SCM group. The overall provider satisfaction with SCM was 88.3%.
The SCM intervention reduces medical complications, length of stay, 30-day readmissions, number of consultants, and cost of care.
本研究旨在探讨外科共同管理（SCM）住院医师项目对一家学术机构患者治疗结果的影响。
由于方法学上的缺陷，先前的研究可能低估了SCM的影响。
这是一项回顾性研究，采用倾向评分加权干预组（n = 16,930）和对照组（n = 3695）。患者于2009年1月至2012年7月（SCM实施前）以及2012年9月至2013年9月（SCM实施后）入住我院骨科或神经外科。使用倾向评分方法、线性回归和差异-in-差异方法，我们估计了前后时期治疗结果的变化，同时对混杂的患者特征进行了调整。
SCM干预与至少有1种医疗并发症的患者比例显著差异降低相关[比值比（OR）0.86；95%置信区间（CI），0.74 - 0.96；P = 0.008]，住院时间至少5天的患者比例（OR 0.75；95% CI，0.67 - 0.84；P < 0.001），因医疗原因的30天再入院率（OR 0.67；95% CI，0.52 - 0.81；P < 0.001），以及至少有2名医疗顾问的患者比例（OR 0.55；95% CI，0.49 - 0.63；P < 0.001）。患者满意度无显著变化（OR 1.08；95% CI，0.87 - 1.33；P = 0.507）。我们估计SCM实施后组每位患者平均节省2642美元至4303美元。医疗服务提供者对SCM的总体满意度为88.3%。
SCM干预可减少医疗并发症、住院时间、30天再入院率、顾问数量和护理成本。
