REORGANIZING AN ACADEMIC MEDICAL-SERVICE - IMPACT ON COST, QUALITY, PATIENT SATISFACTION, AND EDUCATION

Context.-Academic medical centers are under enormous pressure to impro ve quality and cut costs while preserving education. Objective.-To det ermine whether a reorganized academic medical service, led by faculty members who attended more often and became involved earlier and more i ntensively in care, would lower costs without compromising quality and education, Design.-Alternate-day controlled trial. Setting.-Inpatient academic general medical service. Patients.-The 1623 patients dischar ged from the Moffitt-Long medical service between July 1, 1995, and Ju ne 30, 1996. Interventions.-We divided our 4-team inpatient general me dical service into 2 managed care service (MCS) teams and 2 traditiona l service (TS) teams. The MCS faculty served as attending physicians m ore often and were required to provide early input into clinical decis ions, Patients were assigned to teams based on alternate days of admis sion. Main Outcome Measures.-Outcome measures included resource use an d outcomes for MCS vs TS patients, and for MCS patients vs patients se en the previous year, adjusted for demographic characteristics and cas e mix. Satisfaction of patients, house staff, and faculty was also ass essed, as was educational emphasis. Results.-A total of 806 patients w ere admitted to the MCS and 817 to the TS, Demographic characteristics and case mix were similar. Clinical outcomes, including mortality and readmission rates, were also similar, as was patient satisfaction. Re sident and faculty satisfaction were high on both services, The averag e adjusted length of stay of patients on the MCS was 4.3 days vs 4.9 d ays on the TS and 5 days in 1994-1995 (adjusted P=.01 for MCS vs TS; M CS vs 1994-1995, P<.001). Average adjusted hospital costs were $7007 o n the MCS vs $7777 on the TS and $8078 in 1994-1995 (adjusted P=.05 fo r MCS vs TS; MCS vs 1994-1995, P=.002). Conclusions.-A reorganized aca demic medical service, led by faculty members who attended more often and became involved earlier and more intensively, resulted in signific ant resource savings with no changes in clinical outcomes or patient, faculty, and house staff satisfaction.