Study Suggests Hospitalists Can Add Value to Inpatient Care

An 18-month study conducted at a 384-bed community hospital found that including hospitalists in the care team reduced the cost of inpatient care without any impact on the quality of care rendered.

A typical hospitalist program includes nurse practitioners and physician assistants (PAs) to complement in-house physicians. Hospitalists assist the physicians in a variety of ways and can take up the job of patient admissions, consults, rounding visits, and discharges—all driven by specific institutional policies and state regulations. To examine the impact of hospitalists in the program, Physicians Inpatient Care Specialists developed a staffing model that deploys PAs to see a large proportion of its patients in collaboration with physicians. The pilot used a higher ratio of PAs per physician compared with what was typically reported.

The study, conducted at the Anne Arundel Medical Center in Annapolis, Maryland, compared 2 hospitalist groups: one with a high PA-to-physician ratio (expanded PA), with 3 physicians for every 3 PAs and the PAs rounding on 14 patients each day; the other group had a low PA-to-physician ratio (conventional model), with 2 PAs for every 9 physicians and the PAs rounding 9 patients each day. A retrospective analysis used various benchmarks, including in-hospital mortality, cost of care, readmissions, length of stay (LOS), and consultant use for nearly 17,000 adult patients discharged between January 2012 and June 2013.

For each group, each rounding PA was paired with a rounding physician to form a dyad and continuity was maintained daily for these dyads. While the physician collaborated with the PA throughout the day, the PA was independently responsible for their own rounds and decision making, including discharge decisions. An in-person physician visit was mandated at least every third hospital day, including a visit within 24 hours of admission.

The study found no statistical difference in the various patient outcomes that were compared for the 2 groups: in-hospital mortality (odds ratio [OR], 0.89, 95% CI, 0.66-1.19; P = .42), readmissions (OR, 0.95; 95% CI, 0.87-1.04; P = .27), LOS (effect size 0.99 days shorter LOS in expanded PA group; 95% CI, 0.97-1.01 days; P = .34), or consultant use (OR 1.00; 95% CI, 0.94-1.07; P = 0.9). More importantly, the authors report that the cost of care was less in the expanded PA group (effect size 3.52% less; estimated cost $2644 vs $2724; 95% CI 2.66%-4.39%, P <.001).

The authors conclude, “Our results show that expanded use of well-educated PAs functioning within a formal collaboration arrangement with physicians provides similar clinical quality to a conventional PA staffing model with no excess patient care costs.”

Reference

A comparison of conventional and expanded physician assistant hospitalist staffing models at a community hospital. J Clin Outcomes Manag. 2016;23(10):455-461.