Division of Vascular Surgery, Northwell Health - Lenox Hill Hospital, New York City, NY.
Division of Vascular Surgery, Northwell Health - Lenox Hill Hospital, New York City, NY.
Ann Vasc Surg. 2022 Mar;80:12-17. doi: 10.1016/j.avsg.2021.09.050. Epub 2021 Nov 12.
Hospitalists can be instrumental in management of inpatients with multiple comorbidities requiring complex medical care such as vascular surgery patients, as well as an expertise in health care delivery. We instituted a unique hospitalist co-management program and assessed length of stay, 30-day readmission rates and mortality, and performed an overall cost-analysis.
Hospitalist co-management of vascular surgery inpatients was implemented beginning April 2019, and data was studied until March 2020. We compared this data to an eight-month period prior to implementing co-management (7/2018 - 3/2019). Patient-related outcomes that were assessed include length of stay, re-admission index, mortality index, case-mix index. Cost-analysis was performed to look at indirect and direct cost of care.
A total of 1,062 patients were included in the study 520 pre co-management and 542 patients were post-comanagement. Baseline case-mix index was 2.47, and post-comanagement was 2.46 (P >0.05). In terms of average length of stay (aLOS), the baseline aLOS was 5.16 days per patient, while after co-management it was significantly decreased by 1.25 days to 3.91 days (P <0.05). This improvement in length of stay opened an average of 2.4 telemetry beds per day. Similarly, excess days per patient which reflects the expected length of stay based on comorbidities, improved from -0.59 to -1.65, an improvement of -1.46.
Hospitalist co-management improves outcomes for vascular surgery inpatients, decreases length of stay, re-admission and mortality while providing a significant cost-savings. The overall average variable direct cost decreased by $1,732 per patient.
医院医师在管理需要复杂医疗护理的多种合并症患者方面（如血管外科患者）具有重要作用，并且在医疗保健服务方面具有专业知识。我们实施了一项独特的医院医师共同管理计划，并评估了住院时间、30 天再入院率和死亡率，并进行了全面的成本分析。
从 2019 年 4 月开始实施血管外科住院患者的医院医师共同管理，研究数据截止到 2020 年 3 月。我们将这段数据与实施共同管理前的八个月数据（2018 年 7 月至 2019 年 3 月）进行比较。评估的患者相关结果包括住院时间、再入院指数、死亡率指数、病例组合指数。进行成本分析以观察护理的间接和直接成本。
共有 1062 名患者纳入研究，其中 520 名患者在共同管理前，542 名患者在共同管理后。基线病例组合指数为 2.47，共同管理后为 2.46（P >0.05）。在平均住院时间（aLOS）方面，基线 aLOS 为每位患者 5.16 天，而共同管理后显著缩短了 1.25 天，至 3.91 天（P <0.05）。住院时间的这种改善平均每天开放 2.4 张心电监护床。同样，每位患者多余天数（反映基于合并症的预期住院时间）从-0.59 改善至-1.65，改善了-1.46。
医院医师共同管理改善了血管外科住院患者的预后，缩短了住院时间、再入院和死亡率，同时节省了大量成本。每位患者的总体平均可变性直接成本降低了 1732 美元。
