Variation in Length of Stay and Outcomes among Hospitalized Patients Attributable to Hospitals and Hospitalists

James Goodwin, Yu Li Lin, Siddhartha Singh, Yong Fang Kuo

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

BACKGROUND: There have been no prior population-based studies of variation in performance of hospitalists. OBJECTIVE: To measure the variation in performance of hospitalists. DESIGN: Retrospective research design of 100 % Texas Medicare data using multilevel, multivariable models. SUBJECTS: 131,710 hospitalized patients cared for by 1,099 hospitalists in 268 hospitals from 2006-2009. MAIN MEASURES: We calculated, for each hospitalist, adjusted for patient and disease factors (case mix), their patients' average length of stay, rate of discharge home or to skilled nursing facility (SNF) and rate of 30-day mortality, readmissions and emergency room (ER) visits. KEY RESULTS: In two-level models (admission and hospitalist), there was significant variation in average length of stay and discharge location among hospitalists, but very little variation in 30-day mortality, readmission or emergency room visit rates. There was stability over time (2008-2009 vs. 2006-2007) in hospitalist performance. In three-level models including admissions, hospitalists and hospitals, the variation among hospitalists was substantially reduced. For example, hospitals, hospitalists and case mix contributed 1.02 %, 0.75 % and 42.15 % of the total variance in 30-day mortality rates, respectively. CONCLUSIONS: There is significant variation among hospitalists in length of stay and discharge destination of their patients, but much of the variation is attributable to the hospitals where they practice. The very low variation among hospitalists in 30-day readmission rates suggests that hospitalists are not important contributors to variations in those rates among hospitals.

Original languageEnglish (US)
Pages (from-to)370-376
Number of pages7
JournalJournal of General Internal Medicine
Volume28
Issue number3
DOIs
StatePublished - Mar 2013

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Hospitalists
Length of Stay
Diagnosis-Related Groups
Mortality
Hospital Emergency Service
Skilled Nursing Facilities
Medicare

Keywords

  • hospitalist
  • hospitalization
  • length of stay
  • Medicare

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Variation in Length of Stay and Outcomes among Hospitalized Patients Attributable to Hospitals and Hospitalists. / Goodwin, James; Lin, Yu Li; Singh, Siddhartha; Kuo, Yong Fang.

In: Journal of General Internal Medicine, Vol. 28, No. 3, 03.2013, p. 370-376.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: There have been no prior population-based studies of variation in performance of hospitalists. OBJECTIVE: To measure the variation in performance of hospitalists. DESIGN: Retrospective research design of 100 {\%} Texas Medicare data using multilevel, multivariable models. SUBJECTS: 131,710 hospitalized patients cared for by 1,099 hospitalists in 268 hospitals from 2006-2009. MAIN MEASURES: We calculated, for each hospitalist, adjusted for patient and disease factors (case mix), their patients' average length of stay, rate of discharge home or to skilled nursing facility (SNF) and rate of 30-day mortality, readmissions and emergency room (ER) visits. KEY RESULTS: In two-level models (admission and hospitalist), there was significant variation in average length of stay and discharge location among hospitalists, but very little variation in 30-day mortality, readmission or emergency room visit rates. There was stability over time (2008-2009 vs. 2006-2007) in hospitalist performance. In three-level models including admissions, hospitalists and hospitals, the variation among hospitalists was substantially reduced. For example, hospitals, hospitalists and case mix contributed 1.02 {\%}, 0.75 {\%} and 42.15 {\%} of the total variance in 30-day mortality rates, respectively. CONCLUSIONS: There is significant variation among hospitalists in length of stay and discharge destination of their patients, but much of the variation is attributable to the hospitals where they practice. The very low variation among hospitalists in 30-day readmission rates suggests that hospitalists are not important contributors to variations in those rates among hospitals.",
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