Key result
Adding Physician Advocates to multidisciplinary rounds is linked to a ~4% reduction in LOS.
Why the study?
Private-practice physicians admitting their own patients can create challenges for hospital efforts to improve efficiency, quality, and value of care, which physician advocates acting as inpatient liaisons might address.
Does adding Physician Advocates to multidisciplinary rounds reduce length of stay in medical inpatients cared for by private practitioners?
Observational (n=31,632)
No
Does adding Physician Advocates to multidisciplinary rounds reduce length of stay in medical inpatients cared for by private practitioners?
Adding Physician Advocates to multidisciplinary rounds for patients managed by private practitioners improves hospital efficiency by reducing length of stay and 30-day readmissions.
Answers are grounded in this paper and cite their sources.
May support physician advocates on rounds for private inpatients; leaves open prospective confirmation before practice change.
BACKGROUND AND OBJECTIVE: At many hospitals, private-practice physicians still admit their own patients and are accustomed to autonomy in clinical practice. This creates challenges for hospital's efforts to improve the efficiency, quality, and value of care. Experienced inpatient-focused physicians - 'Physician Advocates' - could act as liaisons between private practitioners and the fast-paced inpatient microsystem. METHODS: We conducted a controlled pre-post ('differences-in-differences') analysis at an academic medical center where private-practice physicians care for about 40% of medical inpatients and hospitalist groups care for 60%. In the intervention, 'Physician Advocates' participated in daily multidisciplinary 'Progression of Care Rounds,' offering suggestions to increase care quality for private-practice physicians' patients. Controls were cared for by a large, well-established hospitalist group, which convened separate, unchanged multidisciplinary rounds. Outcomes were length of stay (LOS; primary outcome), 30-day readmissions, and inpatient mortality. RESULTS: In a risk-adjusted analysis of 31,632 medical inpatients, LOS declined by 4 hours more from the baseline period to the post-intervention period in the intervention group relative to the control group (ratio: 0.96, 95% CI: 0.93-0.99, p = 0.004). Readmissions declined 22% more in the intervention group (OR: 0.78, 95% CI: 0.63-0.97, p = 0.023). Mortality was unchanged (OR: 1.23, 95% CI: 0.78-1.93 p-value = 0.378). CONCLUSION: Among inpatients cared for by private practitioners, adding Physician Advocates to multidisciplinary rounds was associated with improved LOS and reduced readmissions - measures of efficiency and value. The Physician Advocates approach should be tested in diverse health systems because it allows hospitals to leverage the expertise of on-site clinicians while respecting the traditional private-practice care model, in which primary care physicians manage their hospitalized patients.
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Groningen et al. (2022) conducted an observational in medical inpatients (n=31,632). Physician Advocates in multidisciplinary Progression of Care Rounds vs. Hospitalist group with separate, unchanged multidisciplinary rounds was evaluated on length of stay (LOS) (ratio 0.96, 95% CI 0.93-0.99, p=0.004). Adding Physician Advocates to multidisciplinary rounds for inpatients cared for by private practitioners significantly reduced length of stay (ratio 0.96; 95% CI 0.93-0.99; p=0.004).
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