What is the clinical evidence from this study?

Study design: Cohort. Population: Medical hospitalizations. Intervention: Hospitalist care vs. Primary care physician care. Primary outcome: Readmissions after discharge (OR 1.08, 95% CI 1.02-1.14).

What does this research mean for the field?

Hospitalist care is associated with decreased hospital length of stay and initial hospital costs, but these savings are offset by higher 30-day post-discharge Medicare costs, emergency department visits, and readmissions. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate the relationship between hospitalist care and medical utilization as well as costs associated with Medicare patients after discharge.

August 2, 2011Annals of Internal Medicine

Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study

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Key result

Hospitalist care was associated with decreased hospital length of stay but higher 30-day post-discharge Medicare costs (+$332, P<0.001) and readmissions (OR 1.08; 95% CI 1.02-1.14).

Why the study?

Does hospitalist care affect hospital length of stay, charges, and post-discharge medical utilization and costs in hospitalized Medicare patients?

Key Points

This research aims to evaluate the relationship between hospitalist care and medical utilization as well as costs associated with Medicare patients after discharge.
Population-based national cohort study
Sample included 5% of Medicare enrollees from 2001 to 2006
Measured length of stay, hospital charges, discharge location, and medical visits post-discharge.
Hospital length of stay was 0.64 days shorter with hospitalist care
Hospital charges were $282 lower, but Medicare costs post-discharge were $332 higher (P < 0.001)
Patients under hospitalist care had increased emergency department visits (OR 1.18) and readmissions (OR 1.08), but fewer primary care visits (OR 0.82).

Study Design

Type

Cohort

Multicenter

Yes

Structured PICO

Does hospitalist care affect hospital length of stay, charges, and post-discharge medical utilization and costs in hospitalized Medicare patients?

Population

A 5% national sample of enrollees in Medicare parts A and B with a primary care physician who were cared for by their primary care physician or a hospitalist during medical hospitalizations from 2001 to 2006.

Intervention

Hospitalist care during medical hospitalization

Comparator

Care by the patient's primary care physician during medical hospitalization

Outcome

Length of stay, hospital charges, discharge location and physician visits, emergency department visits, rehospitalization, and Medicare spending within 30 days after discharge

Main Result

Effect estimate: OR 1.08 (95% CI 1.02-1.14)

Hospitalist care is associated with decreased initial hospital length of stay and costs, but these savings are offset by increased healthcare utilization and costs in the 30 days post-discharge.

Limitations

Observational studies are subject to selection bias.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Shorter stays do not guarantee lower total costs; leaves open net value of hospitalist models in Medicare populations.

Cite This Study

Kuo et al. (2011) conducted a cohort in Medical hospitalizations. Hospitalist care vs. Primary care physician care was evaluated on Readmissions after discharge (OR 1.08, 95% CI 1.02-1.14). Hospitalist care was associated with decreased hospital length of stay but higher 30-day post-discharge Medicare costs (+$332, P<0.001) and readmissions (OR 1.08; 95% CI 1.02-1.14).

synapsesocial.com/papers/6a1c7c0a973ffece4bc3e231 https://doi.org/10.7326/0003-4819-155-3-201108020-00005

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Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider