Hospitalists and Residents and Traditionalists! Oh My! Comparing Three Hospital Primary Care Models

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Pauline Hogan
Performance Improvement Engineer
Franciscan Skemp-Mayo

What is a hospitalist and how sound is the case that the hospitalist model improves quality and efficiency? This session will provide a historical overview of hospital care models and review the outcomes of a two year case study comparing three hospital medicine models on length of stay and quality outcomes at a 200-bed community hospital in Wisconsin.

This study sought the answer to the following questions: Is a full-time hospital medicine model of care more cost efficient than the traditionalist model? Does a full-time hospital medicine model of care provide better clinical quality of care than the traditionalist model of care? The research includes retrospective quantitative analysis of 24 months of hospital patient data comparing length of stay and quality measures among three primary care hospital medicine practices utilized at Franciscan Skemp Healthcare in La Crosse, WI: hospitalists, traditionalists, and Family Health Clinic residency program (FHC). Specifically, the admission and discharge data were analyzed by attending physician role to assess the impact on length of stay and discharge time. Compliance with The Joint Commission on Accreditation of Hospitals' (TJC) patient care protocols for Acute Myocardial Infarction (AMI), Heart Failure (HF), and Community Acquired Pneumonia (CAP) were used to assess quality measures for each hospital medicine group. The clinical quality information system records compliance with these protocols, so this data was used to review outcomes.

The length of stay and discharge time are analyzed for 5,391 patient discharges between Jan 07 to Dec 08 assigned to one of the three groups being considered. The study found a significantly lower length of stay for those patients assigned to the FHC practice versus the traditionalist or hospitalist practices. The study showed a significantly earlier discharge time for traditionalist patients versus hospitalist or FHC patients. Of the 742 patient charts analyzed for quality outcomes, no significant findings were discovered.