Comparison of hospitalists and nonhospitalists in inpatient length of stay adjusting for patient and physician characteristics
Comparison of hospitalists and nonhospitalists in inpatient length of stay adjusting for patient and physician characteristics
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DOI：
10.1111/j.1525-1497.2004.1930415.x
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发表时间：
2004-11-01
影响因子：
5.7
通讯作者：
Sierra, H
中科院分区：
文献类型：
--
作者：
Rifkin, WD;Holmboe, E;Sierra, H
目的：在控制病例组合后，确定住院医师身份对住院时间的独立影响，以及年龄、医师医学院毕业年限、供方数量状况等患者水平和供方水平变量。设计：采用分层随机截距logistic回归模型的观察性回顾性队列研究。单位：三级教学医院。病人：2001年期间所有到内科就诊的病人最初没有被送往重症监护室或冠心病监护室。测量：观察到的住院时间（LOS）与主要诊断相关组（DRG）的比较，住院和非住院患者的特定平均住院时间（LOS）调整了患者的年龄、性别、医生从医学院毕业的年限和医生数量状态。主要结果：9名住院医师出院患者2027例，非住院医师出院患者9361例。平均而言，住院患者更年轻，63.3岁比73.3岁（P < 0.0001）。住院医师毕业时间较晚，分别为13.8年和22.5年（P= 0.02）。研究发现，患者年龄越大，出现高于平均LOS的可能性越大（优势比[OR]， 1.01； 95%可信区间[CI]， 1.01 ~ 1.02; P < .001）。在未经调整的分析中，住院医生不太可能有高于平均水平的LOS （OR, 0.51; 95% CI， 0.28至0.93；P= 0.03）。调整患者年龄和性别、医生性别、医学院毕业年限和医生入院人数五分位数的影响并没有明显改变住院患者仍然不太可能高于平均LOS的点估计（OR, 0.60; 95% CI， 0.32至1.11；P= 0.11）。结论：对于给定的原则DRG，住院患者比非住院患者更不可能超过平均LOS。这种影响相当大，因为住院状态将高于平均LOS的可能性降低了约49%。调整患者年龄、医师毕业年限和入院人数并没有显著改变这一发现。进一步的研究应侧重于确定导致住院治疗影响的具体做法。
OBJECTIVE: To determine the independent effect of hospitalist status upon inpatient length of stay after controlling for case mix, as well as patient-level and provider-level variables such as age, years since physician medical school graduation, and volume status of provider.DESIGN: Observational retrospective cohort study employing a hierarchical random intercept logistic regression model.SETTING: Tertiary-care teaching hospital.PATIENTS: All admissions during 2001 to the department of medicine not sent initially to the medical intensive care unit or coronary care unit.MEASUREMENTS: Observed length of stay (LOS) compared to principle diagnosis related group (DRG)-specific mean LOS for hospitalist and nonhospitalist patients adjusting for patient age, gender, years since physician graduation from medical school, and physician volume status.MAIN RESULTS: The 9 hospitalists discharged 2,027 patients while the nonhospitalists discharged 9,361 patients. On average, hospitalist patients were younger, 63.3 versus 73.3 years (P < .0001). Hospitalists were more recently graduated from medical school, 13.8 versus 22.5 years (P= .02). Each year of patient age was found to increase the likelihood of an above average LOS (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.01 to 1.02; P < .001). In unadjusted analysis, hospitalists were less likely to have an above average LOS (OR, 0.51; 95% CI, 0.28 to 0.93; P= .03). Adjustment for effects of patient age and gender, physician gender, years since medical school graduation, and quintile of physician admission volume did not appreciably change the point estimate that hospitalist patients remained less likely to have above average LOS (OR, 0.60; 95% CI, 0.32 to 1.11; P= .11).CONCLUSIONS: For a given principle DRG, hospitalist patients were less likely to exceed the average LOS than were nonhospitalist patients. This effect was rather large, in that hospitalist status reduced the likelihood of above average LOS by about 49%. Adjustment for patient age, years since physician graduation, and admission volume did not significantly alter this finding. Further research should focus on identifying specific practices that account for hospitalism's effects.