J.A. Perez Jr is professor of clinical medicine, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. M. Awar is assistant professor of clinical medicine, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. A. Nezamabadi is a hospitalist, Salinas Valley Healthcare System, Salinas, California. At the time of the study, the author was a third-year internal medicine resident, Houston Methodist Hospital, Houston, Texas. R. Ogunti is a first-year resident, Internal Medicine, Howard University, Washington, DC. At the time of the study, the author was a project specialist, Department of Systems Medicine and Bioengineering, Houston Methodist Hospital, Houston, Texas. M. Puppala is a senior applications analyst, Department of Systems Medicine and Bioengineering, Houston Methodist Hospital, Houston, Texas. L. Colton is assistant professor of clinical medicine, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. J.M. Clewing is assistant professor of clinical medicine, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. S. Ketkar is clinical quality analytics/integration manager, Houston Methodist Hospital, Houston, Texas. S.T.C. Wong is professor and chair, Department of Systems Medicine and Bioengineering, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas. R.J. Robbins is professor and chair, Department of Medicine, Houston Methodist Institute for Academic Medicine and Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas.
Acad Med. 2018 Mar;93(3):491-497. doi: 10.1097/ACM.0000000000002026.
To compare costs of care and quality outcomes between teaching and nonteaching hospitalist services, while testing the assumption that resident-driven care is more expensive.
Records of inpatients with the top 20 Medicare Severity Diagnosis-Related Groups admitted to the University Teaching Service (UTS) and nonteaching hospitalist service (NTHS) at Houston Methodist Hospital from 2014-2015 were analyzed retrospectively. Direct costs of care, length of stay (LOS), in-hospital mortality (IHM), 30-day readmission rate (30DRR), and consultant utilization were compared between the UTS and NTHS. Propensity score matching and case mix index (CMI) were used to mitigate differences in baseline characteristics. To compare outcomes between matched groups, the Wilcoxon rank sum test and chi-square test were used. A sensitivity analysis was conducted using multivariable regression analysis.
From the overall study population of 8,457 patients, 1,041 UTS and 3,123 NTHS patients were matched. CMI was 1.07 for each group. The UTS had lower direct costs of care per case ($5,028 vs. $5,502, P = .006), lower LOS (4.7 vs. 5.2 days, P = .0002), and lower consultant utilization (1.0 vs. 1.6, P ≤ .0001) versus the NTHS. The UTS and NTHS 30DRR (17.2% vs. 19.3%, P = .110) and IHM (2.9% vs. 3.7%, P = .206) were comparable. The multivariable regression analysis validated the matched data and identified an incremental cost savings of $333/UTS patient.
Patients of an academic hospitalist service had significantly shorter LOS, fewer consultants, and lower direct care costs than comparable patients of a nonteaching service.
比较教学医院和非教学医院医生服务的护理成本和质量结果，同时检验住院医师主导的护理费用更高的假设。
回顾性分析 2014 年至 2015 年休斯顿卫理公会医院 UTS 和 NTHS 收治的 Medicare 严重诊断相关组前 20 位的住院患者记录。比较 UTS 和 NTHS 之间的护理直接成本、住院时间（LOS）、院内死亡率（IHM）、30 天再入院率（30DRR）和顾问利用率。采用倾向评分匹配和病例组合指数（CMI）来减轻基线特征的差异。为了比较匹配组之间的结果，采用 Wilcoxon 秩和检验和卡方检验。采用多变量回归分析进行敏感性分析。
在 8457 名患者的总体研究人群中，1041 名 UTS 和 3123 名 NTHS 患者进行了匹配。每组 CMI 为 1.07。UTS 的每例护理直接成本较低（$5028 比 $5502，P =.006），住院时间较短（4.7 天比 5.2 天，P =.0002），顾问利用率较低（1.0 比 1.6，P ≤.0001）与 NTHS。UTS 和 NTHS 的 30DRR（17.2%比 19.3%，P =.110）和 IHM（2.9%比 3.7%，P =.206）相似。多变量回归分析验证了匹配数据，并确定 UTS 患者的增量成本节省为$333/UTS 患者。
与非教学服务的可比患者相比，学术医院医生服务的患者 LOS 更短、顾问更少、直接护理成本更低。
