Hospitalization and Post-hospitalization Outcomes Among Teaching Internal Medicine, Employed Hospitalist, and Locum Tenens Hospitalist Services in a Tertiary Center: a Prospective Cohort Study

Hospitalization and Post-hospitalization Outcomes Among Teaching Internal Medicine, Employed Hospitalist, and Locum Tenens Hospitalist Services in a Tertiary Center: a Prospective Cohort Study

Background There are no prospective studies comparing hospitalization and post-hospitalization outcomes between teaching internal medicine services and non-teaching hospitalists, and no prospective studies comparing these outcomes between locum and employed hospitalists. Objective To compare the len...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM Vol. 36; no. 10; pp. 3040 - 3051
Main Authors: Mustafa Ali, Moaath K., Sabha, Marwa M., Mustafa, Sarah K., Banifadel, Momen, Ghazaleh, Sami, Aburayyan, Kanana M, Ghanim, Marcel T., Awad, Mohammed T., Gekonde, Damynus N., Ambati, Amala R., Ramahi, Ahmad, Elzanaty, Ahmed M., Nesheiwat, Zeid, Shastri, Pinang M, Al-Sarie, Mohammad, McGready, John
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01-10-2021
Springer Nature B.V
Subjects:
Cohort analysis
Costs
Hospital costs
Hospitalists
Hospitalization
Internal Medicine
Length of stay
Medicine
Medicine & Public Health
Mortality
Original Research
Patients
Physicians
Statistical analysis
length of stay
mortality
patient readmission
hospitalist
hospital costs
locum
teaching internal medicine
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Summary:Background There are no prospective studies comparing hospitalization and post-hospitalization outcomes between teaching internal medicine services and non-teaching hospitalists, and no prospective studies comparing these outcomes between locum and employed hospitalists. Objective To compare the length of stay, hospital costs readmission rate, and mortality rate in patients treated by teaching internal medicine services vs. hospitalists and among patients treated by locum vs. employed hospitalists. Design Prospective cohort study. Propensity score was used to obtain weighted estimates. Setting Referral center. Patients All patients 18 years and older admitted to internal medicine services. Intervention Treatment by teaching internal medicine services vs. hospitalists. Treatment by locum hospitalists vs. employed hospitalists. Main Measures Primary outcome was adjusted length of stay and secondary outcomes included hospital cost, inpatient mortality, 30-day all-cause readmission, and 30-day mortality. Key Results A total of 1273 patients were admitted in the study period. The mean patient age was 61 ± 19 years, and the sample was 52% females. Teaching internal medicine physicians admitted 526 patients and non-teaching hospitalists admitted 747 patients. Being seen exclusively by teaching internal medicine physicians comports with a shorter adjusted hospital stay by 0.6 days (95% CI − 1.07 to − 0.22, P = .003) compared to non-teaching hospitalists. Adjusted length of stay was 1 day shorter in patients seen exclusively by locums compared to patients seen exclusively by employed services (95% CI − 1.6 to − 0.43, P < .001) with an adjusted average hospital cost saving of 1339 dollars (95% CI − 2037 to − 642, P < .001). There was no statistically significant difference in other outcomes. Conclusions Teaching internal medicine services care was associated with a shorter stay but not with increased costs, readmission, or mortality compared to non-teaching services. In contrary to the “expected,” patients treated by locums had shorter stays and decreased hospital costs but no increase in readmissions or mortality.
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ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-020-06578-4