Faculty Collaboration Database

A comparison of outcomes of general medical inpatient care provided by a hospitalist-physician assistant model vs a traditional resident-based model. J Hosp Med 2011 Mar;6(3):122-30

Date

03/10/2011

Pubmed ID

21387547

DOI

10.1002/jhm.826

Scopus ID

2-s2.0-79952465041   21 Citations

Abstract

BACKGROUND: Residency reform in the form of work hour restrictions has forced academic medical centers to develop alternate models of care to provide inpatient care. One such model is the use of physician assistants (PAs) with hospitalists. However, these models of care have not been widely evaluated.

OBJECTIVE: To compare the outcomes of inpatient care provided by a hospitalist-PA (H-PA) model with the traditional resident based model.

DESIGN, SETTING AND PATIENTS: We conducted a retrospective cohort study of 9681 general medical (GM) hospitalizations between January 2005 and December 2006 using a hospital administrative database. We used multivariable mixed models to adjust for a wide variety of potential confounders and account for multiple patient visits to the hospital to compare the outcomes of 2171 hospitalizations to H-PA teams with those of 7510 hospitalizations to resident teams (RES).

MEASUREMENTS: Length of stay (LOS), charges, readmission within 7, 14, and 30 days and inpatient mortality.

RESULTS: Inpatient care provided by H-PA teams was associated with a 6.73% longer LOS (P = 0.005) but charges, risk of readmission at 7, 14, and 30 days and inpatient mortality were similar to resident-based teams. The increase in LOS was dependent on the time of admission of the patients.

CONCLUSIONS: H-PA team-based GM inpatient care was associated with a higher LOS but similar charges, readmission rates, and inpatient mortality to traditional resident-based teams, a finding that persisted in sensitivity analyses.

Author List

Singh S, Fletcher KE, Schapira MM, Conti M, Tarima S, Biblo LA, Whittle J

Authors

Kathlyn E. Fletcher MD Professor in the Medicine department at Medical College of Wisconsin
Sergey S. Tarima PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Hospital Mortality
Hospitalists
Hospitalization
Humans
Internship and Residency
Male
Middle Aged
Patient Care Team
Physician Assistants
Retrospective Studies
Treatment Outcome
Young Adult