Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
Hosp Pract (1995). 2021 Apr;49(2):119-126. doi: 10.1080/21548331.2021.1882238. Epub 2021 Feb 9.
: Given the high cost of inpatient stays, hospital systems are investigating ways to decrease lengths of stay while ensuring high-quality care. The goal of this study was to determine if patients in teaching teams (hospitalist teams with residents and interns) had a higher length of stay after adjusting for relevant confounders compared to hospitalist-only teams (staffed only by attending physicians).: Using a retrospective design, we investigated differences in length of stay for 17,577 inpatient encounters over a 2-year period. Length of stay was calculated based on the time between hospital admission and hospital discharge with no removal of outliers. Encounters were assigned to teams based on the discharge provider. Teams were grouped based on whether they were teaching teams or nonteaching teams. Since the length of stay was not normally distributed, it was modeled first using generalized linear models with gamma distribution and log link, and secondly by quantile regression. Models were adjusted for age, gender, race, medicine vs. non-medicine unit, MS-DRGs, and comorbidities.: Using gamma models to account for the skewed nature of the data, the length of stay for encounters assigned to teaching teams was 0.56 days longer (β = 0.10 95% CI 0.06 0.14) than for nonteaching teams after adjustment. Using quantile regression, teaching teams had encounters on average 0.63 days longer (95% CI 0.44 0.81) than nonteaching teams at the 75 percentile and 1.19 days longer (95% CI 0.77 1.61) compared to nonteaching teams at the 90 percentile after adjustment.: After adjusting for demographics and clinical factors, teaching teams on average had lengths of stay that were over half day longer than nonteaching teams. In addition, for the longest encounters, differences between teaching and nonteaching teams were over 1-day difference. Given these results, process improvement opportunities exist within teaching teams regarding length of stay, particularly for longer encounters.
: 鉴于住院治疗费用高昂，医院系统正在研究在确保高质量护理的同时缩短住院时间的方法。本研究的目的是确定与仅由主治医生组成的住院医师团队（由主治医生和住院医师组成的团队）相比，在调整相关混杂因素后，教学团队（有住院医师和实习医生的医院团队）的患者住院时间是否更长。: 使用回顾性设计，我们调查了在两年期间 17577 例住院患者的住院时间差异。住院时间是根据住院和出院之间的时间计算的，没有去除异常值。根据出院医生将就诊分配给团队。根据团队是否为教学团队或非教学团队对团队进行分组。由于住院时间不是正态分布，因此首先使用具有伽马分布和对数链接的广义线性模型对其进行建模，其次使用分位数回归对其进行建模。模型调整了年龄、性别、种族、内科与非内科病房、MS-DRGs 和合并症。: 使用伽马模型来解释数据的偏态性质，与非教学团队相比，分配给教学团队的就诊的住院时间长 0.56 天（β=0.10，95%CI 0.06-0.14）。使用分位数回归，教学团队的就诊平均比非教学团队长 0.63 天（95%CI 0.44-0.81），在第 75 百分位数，以及长 1.19 天（95%CI 0.77-1.61），在第 90 百分位调整后与非教学团队相比。: 在调整人口统计学和临床因素后，教学团队的平均住院时间比非教学团队长半天以上。此外，对于最长的就诊，教学团队和非教学团队之间的差异超过 1 天。鉴于这些结果，教学团队在住院时间方面存在改进流程的机会，特别是对于较长的就诊。
