Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system

PURPOSE: Previous studies have examined the effects of hospitalists in urba n academic hospitals. We compared the outcomes of patients treated by hospi talists with those of patients treated by internists at a 647-bed rural com munity hospital. SUBJECTS AND METHODS: The 443 patients in the hospitalists' 10 most common diagnosis-related groups (DRGs) were compared with 1,681 patients in the sa me DRGs who were cared for by internists in fiscal year 1998. Length of sta y, cost of care, patient illness severity, patient satisfaction, 30-day rea dmission rate, inpatient mortality, discharge status, and resource utilizat ion were compared. RESULTS: The hospitalists' patients had a shorter mean (+/- SD) length of s tay (4.1 +/- 3.0 days versus 5.5 +/- 4.9 days, P <0.001) and their cost of care was less than that of the internists' patients ($4,098 +/- $2,455 vers us $4,658 +/- $4,084, P <0.001). Analyses that adjusted for patient age, ra ce, sex, insurance status, severity of illness, and specific medical comorb idities confirmed these differences. The differences between hospitalists a nd internists were most apparent among very ill patients. Mortality rates w ere similar (4.5% for hospitalists versus 4.9% for internists, P = 0.80), a s were the readmission rates (4.5% for hospitalists versus 5.6% for interni sts, P = 0.41). Patient satisfaction was similar for both groups. The inter nists used more resources in 8 of 11 categories. CONCLUSIONS:The hospitalists provided cost-effective care, particularly for the sickest patients, with good outcomes and patient satisfaction. (C) 200 0 by Excerpta Medica, Inc.