Josué Patien Epané, MBA, PhD, is Assistant Professor, Department of Health Care Administration and Policy, University of Nevada, Las Vegas. E-mail:
Health Care Manage Rev. 2019 Jan/Mar;44(1):10-18. doi: 10.1097/HMR.0000000000000170.
Hospitalists, or physicians specializing in hospital-based practice, have grown significantly since they were first introduced in the United States in the mid-1990s. Prior studies on the impact of hospitalists have focused on costs and length of stay. However, there is dearth of research exploring the relationship between hospitals' use of hospitalists and organizational performance.
Using a national longitudinal sample of acute care hospitals operating in the United States between 2007 and 2014, this study explores the impact of hospitalists staffing intensity on hospitals' financial performance.
Data sources for this study included the American Hospital Association Annual Survey, the Area Health Resources File, and the Centers for Medicare & Medicaid Services' costs reports and Case Mix Index files. Data were analyzed using a panel design with facility and year fixed effects regression.
Results showed that hospitals that switched from not using hospitalists to using a high hospitalist staffing intensity had both increased patient revenues and higher operating costs per adjusted patient day. However, the higher operating costs from high hospitalist staffing intensity were offset by increased patient revenues, resulting in a marginally significant increase in operating profitability (p < .1).
These findings suggest that the rise in the use of hospitalists may be fueled by financial incentives such as increased revenues and profitability in addition to other drivers of adoption.
自 20 世纪 90 年代中期在美国首次引入以来，医院医师（专门从事医院内实践的医生）的数量显著增长。先前关于医院医师影响的研究主要集中在成本和住院时间上。然而，几乎没有研究探索医院使用医院医师与组织绩效之间的关系。
本研究使用了 2007 年至 2014 年期间在美国运营的急性护理医院的全国纵向样本，探讨了医院医师人员配备强度对医院财务绩效的影响。
本研究的数据来源包括美国医院协会年度调查、区域卫生资源文件以及医疗保险和医疗补助服务中心的成本报告和病例组合指数文件。使用设施和年度固定效应回归的面板设计对数据进行了分析。
结果表明，从不使用医院医师转变为使用高医院医师人员配备强度的医院，患者收入增加，每位调整后患者的运营成本也增加。然而，高医院医师人员配备强度带来的较高运营成本被患者收入的增加所抵消，导致运营盈利能力略有显著提高（p<0.1）。
这些发现表明，除了采用的其他驱动因素外，增加收入和盈利能力等财务激励因素可能推动了医院医师使用的增加。
