The impact of an inpatient physician program on quality, utilization, and satisfaction

Objective: To evaluate an inpatient physician system initiated in lune 1996 for all patients of a health maintenance organization admitted to the gene ral medicine service of an urban teaching hospital. In the new program, att ending physician duties were transferred from the patient's own general int ernist to another internist sewing on a hospital-based rotation. Study Design: Cohort with historical controls. Participants and Methods:. We compared the following measures before and af ter the new inpatient physician program began: (1) hospital length of stay and total charges, (2) outcomes related to quality of care, (3) primary car e physician satisfaction, and (4) housestaff satisfaction. Differences befo re and after initiation of the inpatient physician program were evaluated u sing multivariate analyses to adjust for patient differences and secular tr ends. Results: There were 2265 patients discharged from the general medical servi ce in the year following implementation of the inpatient physician program. Postintervention average length of stay decreased from 3.5 to 3.0 days (P <.001). In multivariate analyses, average length of stay was reduced by 0.3 days (P =.008), and total hospital charges were reduced an average of $426 per admission (P=.001). In-hospital mortality rates, percentage of patient s discharged home directly, and 30-day read-mission rates did not change si gnificantly in the postintervention period. Satisfaction among primary care physicians was high, with 90% of those answering a survey responding that they would recommend a similar program to other primary care groups. Medica l housestaff satisfaction with their educational experience also increased. Conclusions: implementation of an inpatient physician program at this insti tution significantly decreased resource utilization while maintaining or im proving quality of care. Satisfaction with the program was high among prima ry care internists and housestaff.