Department of General Internal Medicine, Takatsuki General Hospital, Japan.
Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Japan.
Intern Med. 2023 Apr 15;62(8):1131-1138. doi: 10.2169/internalmedicine.8944-21. Epub 2022 Sep 6.
Objective The hospitalist system in the United States has been considered successful in terms of the quality of care and cost effectiveness. In Japan, however, its efficacy has not yet been extensively examined. This study examined the impact of the hospitalist system on the quality of care and healthcare economics in a Japanese population using treatment of urinary tract infection as an example. Methods We analyzed 271 patients whose most resource-consuming diagnosis at admission was urinary tract infection between April 2017 and March 2019. Propensity-matched analyses were performed to compare health care economics and the quality of care between the hospitalist system and the conventional system. Results In matched pairs, care by the hospitalist system was associated with a significantly shorter length of stay than that by the conventional system. The quality of care (oral antibiotics switch rate, rate of appropriate antibiotics change based on urine or blood culture results, detection rate of urinary tract infection etiology and the number of laboratory tests) was also considered to be favorably impacted by the hospitalist system. Although not statistically significant, hospital costs tended to be lower with the hospitalist system than with the conventional system. The mortality rate and 30-day readmission were also not significantly different between the groups. Conclusion The hospitalist system had a favorable impact on the quality of care and length of stay without increasing readmission in patients with urinary tract infection. This study is further evidence of the strong potential for the positive impact of an implemented hospitalist system in Japan.
目的 美国的医院医师制度在医疗质量和成本效益方面被认为是成功的。然而，在日本，其疗效尚未得到广泛检验。本研究以尿路感染的治疗为例，考察了医院医师制度对日本人群医疗质量和医疗经济学的影响。
方法 我们分析了 2017 年 4 月至 2019 年 3 月期间，271 名入院时最消耗资源的诊断为尿路感染的患者。采用倾向评分匹配分析比较医院医师制度与传统制度的医疗经济学和医疗质量。
结果 在匹配的患者中，医院医师制度组的住院时间明显短于传统制度组。医院医师制度也被认为对医疗质量（口服抗生素转换率、根据尿液或血液培养结果调整抗生素的比率、尿路感染病因的检出率和实验室检查次数）有积极影响。虽然没有统计学意义，但医院医师制度组的住院费用趋于低于传统制度组。两组患者的死亡率和 30 天再入院率也无显著差异。
结论 医院医师制度对尿路感染患者的医疗质量和住院时间有积极影响，而不会增加再入院率。本研究进一步证明了在日本实施医院医师制度具有积极影响的潜力。
