Effect of hospitalists on length of stay in the medicare population: Variation according to hospital and patient characteristics

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Abstract

OBJECTIVES: To assess how shorter length of stay (LOS) associated with hospitalist care than with care by other physicians varied according to patient and hospital characteristics and to explore whether these differences in LOS changed over time in the Medicare population. DESIGN: Retrospective cohort study using data from a 5% national sample of Medicare beneficiaries. SETTING: Hospital. PARTICIPANTS: To examine temporal trends, 1,981,654 Medicare admissions in 2001 to 2006 at 5,036 U.S. hospitals were used. To examine the influence of patient and hospital characteristics, 314,590 admissions in 2006 were used. MEASUREMENTS: Hospital LOS. RESULTS: In multivariable analyses controlling for patient and hospital characteristics, differences in LOS associated with hospitalist care increased from 0.02 fewer days in 2001/02 to 0.22 days in 2003/04 to 0.35 days in 2005/06. For 2006 admissions, differences in LOS were greater in older patients and patients with a higher diagnosis-related group (DRG) weight. The differences were three times as great for medical as for surgical DRGs, with greater differences in LOS at nonprofit than for-profit hospitals and at community than teaching hospitals. CONCLUSION: The shorter LOS associated with hospitalist care would appear to be greatest in older, complicated, nonsurgical patients cared for at community hospitals.

Original languageEnglish (US)
Pages (from-to)1649-1657
Number of pages9
JournalJournal of the American Geriatrics Society
Volume58
Issue number9
DOIs
StatePublished - 2010

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Hospitalists
Medicare
Length of Stay
Population
Diagnosis-Related Groups
Community Hospital
Teaching Hospitals
Cohort Studies
Retrospective Studies
Physicians
Weights and Measures

Keywords

  • hospitalist
  • length of stay
  • Medicare

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Medicine(all)

Cite this

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title = "Effect of hospitalists on length of stay in the medicare population: Variation according to hospital and patient characteristics",
abstract = "OBJECTIVES: To assess how shorter length of stay (LOS) associated with hospitalist care than with care by other physicians varied according to patient and hospital characteristics and to explore whether these differences in LOS changed over time in the Medicare population. DESIGN: Retrospective cohort study using data from a 5{\%} national sample of Medicare beneficiaries. SETTING: Hospital. PARTICIPANTS: To examine temporal trends, 1,981,654 Medicare admissions in 2001 to 2006 at 5,036 U.S. hospitals were used. To examine the influence of patient and hospital characteristics, 314,590 admissions in 2006 were used. MEASUREMENTS: Hospital LOS. RESULTS: In multivariable analyses controlling for patient and hospital characteristics, differences in LOS associated with hospitalist care increased from 0.02 fewer days in 2001/02 to 0.22 days in 2003/04 to 0.35 days in 2005/06. For 2006 admissions, differences in LOS were greater in older patients and patients with a higher diagnosis-related group (DRG) weight. The differences were three times as great for medical as for surgical DRGs, with greater differences in LOS at nonprofit than for-profit hospitals and at community than teaching hospitals. CONCLUSION: The shorter LOS associated with hospitalist care would appear to be greatest in older, complicated, nonsurgical patients cared for at community hospitals.",
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AU - Goodwin, James

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AB - OBJECTIVES: To assess how shorter length of stay (LOS) associated with hospitalist care than with care by other physicians varied according to patient and hospital characteristics and to explore whether these differences in LOS changed over time in the Medicare population. DESIGN: Retrospective cohort study using data from a 5% national sample of Medicare beneficiaries. SETTING: Hospital. PARTICIPANTS: To examine temporal trends, 1,981,654 Medicare admissions in 2001 to 2006 at 5,036 U.S. hospitals were used. To examine the influence of patient and hospital characteristics, 314,590 admissions in 2006 were used. MEASUREMENTS: Hospital LOS. RESULTS: In multivariable analyses controlling for patient and hospital characteristics, differences in LOS associated with hospitalist care increased from 0.02 fewer days in 2001/02 to 0.22 days in 2003/04 to 0.35 days in 2005/06. For 2006 admissions, differences in LOS were greater in older patients and patients with a higher diagnosis-related group (DRG) weight. The differences were three times as great for medical as for surgical DRGs, with greater differences in LOS at nonprofit than for-profit hospitals and at community than teaching hospitals. CONCLUSION: The shorter LOS associated with hospitalist care would appear to be greatest in older, complicated, nonsurgical patients cared for at community hospitals.

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