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J Gen Intern Med ; 19(5 Pt 1): 395-401, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15109336

RESUMO

OBJECTIVE: To examine the effects of internal medicine specialty and physician experience on inpatient resource use and clinical outcomes on an academic general medicine service. DESIGN: A 1-year retrospective cohort study. SETTING: The University of Michigan Hospitals, Ann Arbor, Michigan. PATIENTS: Two thousand six hundred seventeen admissions to the general medicine service from July 2001 to June 2002, excluding those for whom data were incomplete (n = 18). MEASUREMENTS AND MAIN RESULTS: Length of stay (LOS) and total hospital costs were used to measure resource utilization. Hospital mortality and 14-day and 30-day readmission rates were used to measure clinical outcomes. Adjusted mean LOS was significantly greater for rheumatologists (0.56 days greater; P =.002) and endocrinologists (0.38 days greater; P =.03) compared to general internists. Total costs were lower for general internists compared to endocrinologists ($1100 lower; P =.01) and rheumatologists ($431 lower; P =.07). Hospitalists showed a trend toward reduced LOS compared to all other physicians (0.31 days lower; P =.06). The top two deciles of physicians stratified by recent inpatient general medical experience showed significantly reduced LOS compared to all other physicians (0.35 days lower; P =.04). No significant differences were seen in readmission rates or in-hospital mortality among the various physician groups. CONCLUSIONS: General internists had lower lengths of stay and costs compared to endocrinologists and rheumatologists. Hospitalists showed a trend toward reduced LOS compared to all other physicians. Recent inpatient general medicine experience appears to be a determinant of reduced inpatient resource use.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Economia Médica , Médicos Hospitalares/normas , Hospitalização , Medicina Interna/economia , Corpo Clínico Hospitalar/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Especialização , Centros Médicos Acadêmicos/normas , Feminino , Custos Hospitalares/estatística & dados numéricos , Médicos Hospitalares/classificação , Humanos , Medicina Interna/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Corpo Clínico Hospitalar/classificação , Medicina/estatística & dados numéricos , Michigan , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Estudos Retrospectivos
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