The Value of a Hospitalist Service

We studied patients of a hospitalistteaching service and patients receiving routine private care (controlsubjects). We sought to evaluate whether inpatients cared for by anacademic hospitalist service had lower lengths of stay and resourceutilization rates. Using monthly hospitalcensus data, 477 hospitalist cases and 1,160 control cases wereselected by explicit criteria from the Medicaid population of a large, university-affiliated, community medical center between July 1, 1996, and June 30, 1997. Outcomes in hospitalist faculty patients werecompared to those of control patients under the care of privateproviders. Median length of stay was 4 daysfor control subjects and 3 days for the hospitalist service(p < 0.0001). Median total cost per case was $4,853 for controlsubjects and $4,002 for hospitalist patients (p < 0.0001). Onlypatients ≥ 65 years old showed statistically significant reductionsin both length of stay (p < 0.0001) and total cost (p = 0.002). Subspecialty consultation rates were 37.6% for control subjects and16.6% for hospitalist cases (p < 0.0001). We noted increasingconsultations for patients ≥ 65 years old, especially in the controlgroup (p = 0.001). No significant differences in mortality, 30-dayreadmissions, or interfacility transfers were observed. Patients cared for by an academichospitalist service that includes actively participating medicalresidents appear to have lower lengths of stay, total costs, andconsultation rates than patients receiving routine private care. Thereductions are largely observed among patients ≥ 65 yearsold.