Yong-Fang Kuo, PhD; James S. Goodwin, MD
Grant Support: By the National Institute on Aging (grants 1R01-AG033134 and P30AG024832) and the National Cancer Institute (grant K05-CA134923).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0086.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Kuo (e-mail, email@example.com).
Requests for Single Reprints: Yong-Fang Kuo, PhD, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0177; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Kuo and Goodwin: Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0177.
Author Contributions: Conception and design: Y.F. Kuo, J.S. Goodwin.
Analysis and interpretation of the data: Y.F. Kuo, J.S. Goodwin.
Drafting of the article: Y.F. Kuo, J.S. Goodwin.
Critical revision of the article for important intellectual content: Y.F. Kuo, J.S. Goodwin.
Final approval of the article: Y.F. Kuo, J.S. Goodwin.
Provision of study materials or patients: Y.F. Kuo, J.S. Goodwin.
Statistical expertise: Y.F. Kuo.
Administrative, technical, or logistic support: Y.F. Kuo, J.S. Goodwin.
Collection and assembly of data: Y.F. Kuo, J.S. Goodwin.
Kuo Y, Goodwin JS. Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study. Ann Intern Med. 2011;155:152-159. doi: 10.7326/0003-4819-155-3-201108020-00005
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Published: Ann Intern Med. 2011;155(3):152-159.
Hospitalist care has grown rapidly, in part because it is associated with decreased length of stay and hospital costs. No national studies examining the effect of hospitalist care on hospital costs or on medical utilization and costs after discharge have been done.
To assess the relationship of hospitalist care with hospital length of stay, hospital charges, and medical utilization and Medicare costs after discharge.
Population-based national cohort study.
Hospital care of Medicare patients.
A 5% national sample of enrollees in Medicare parts A and B with a primary care physician who were cared for by their primary care physician or a hospitalist during medical hospitalizations from 2001 to 2006.
Length of stay, hospital charges, discharge location and physician visits, emergency department visits, rehospitalization, and Medicare spending within 30 days after discharge.
In propensity score analysis, hospital length of stay was 0.64 day less among patients receiving hospitalist care. Hospital charges were $282 lower, whereas Medicare costs in the 30 days after discharge were $332 higher (P < 0.001 for both). Patients cared for by hospitalists were less likely to be discharged to home (odds ratio, 0.82 [95% CI, 0.78 to 0.86]) and were more likely to have emergency department visits (odds ratio, 1.18 [CI, 1.12 to 1.24]) and readmissions (odds ratio, 1.08 [CI, 1.02 to 1.14]) after discharge. They also had fewer visits with their primary care physician and more nursing facility visits after discharge.
Observational studies are subject to selection bias.
Decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.
National Institute on Aging and National Cancer Institute.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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