University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• The implementation of hospitalists is on the rise in the US due to the presumed benefit regarding efficiency of inpatient care; there is little data, however, supporting this theory.

Clinical Bottom Lines

1. The implementation of full-time hospitalists may reduce length of stay, cost per case, and readmission rate.¹
2. The data from this paper recommend positive but cautious approach to implementation of this model in certain hospital settings, inasmuch as cost-containment is an issue.

Summary of Key Evidence

1. The study looked at mandatory hand-off of patients from a large primary care group to hospitalists for a one-year period compared with multiple retrospective and simultaneous control groups.
2. Study and control groups were similar in age, sex, insurance type, and case-mix index. 
3. Mean length of stay decreased by 27% (8.75 days to 6.33 days) in study group compared with the same practice in the prehospitalist year; decreases in mean were only 7%-9% in comparison groups. 
4. Mean cost per case decreased from $6275 to $5258 in study group; cost of care actually went up in comparison groups, prehospitalist to hospitalist year. 
5. Readmission rates were lower in the study group, but only took into account readmissions to the study hospital.

Additional Comments

• The data in this study are consistent with expected outcomes of implementing a hospitalist system.
• These data represent a single institution, time point, and model of care.
• Differences were greatest with cases with longest lengths-of-stay.
• Applicability to other hospitals is very limited: control groups were quite dissimilar (thus the number of comparison groups), and bottom line here is only the implication for the business aspects of the hospital, with educational issues, and patient and physician satisfaction not addressed.

Citation

1. Diamond HS, et al. The effect of full-time faculty hospitalists on the efficiency of care at a community teaching hospital.  Ann Int Med. 1998; 129(3):197-203.
2. Wachter RM and Goldmann DR (eds.).  The hospitalist movement in the United States.  Ann Int Med. 1998; 130(4, part 2):337-387.

CAT Author: Stephen Burgess, MD

CAT Appraisers: <Reviewers>, MD

Date appraised: March 18, 1999