At a time when managed care is forcing hospitals to cut costs, a new UC San Francisco study has found that increasing the involvement of faculty doctors who specialize in hospital care may be a key to shorter, less costly hospital stays that don't compromise quality or teaching.
The study, published in the May 20th edition of the Journal of the American Medical Association, found that patients spend less time in the hospital--and their care costs less as a result--when their cases are managed by doctors in the recently emerged specialty of hospital care, called hospitalists.
Traditionally, residents, who are medical school graduates in the late stages of training, manage inpatient care in teaching hospitals.
The role of the hospitalist is a departure from the way faculty doctors traditionally have functioned in academic hospitals. Under the traditional model, faculty members serve as advisors to the residents and rotate in that role infrequently, often just one month a year.
"What you have with the hospitalist model is more direct supervision by individuals who are more experienced in this attending role, more skilled in it and for whom this role is a larger part of their professional identity," said Robert M. Wachter, MD, UCSF associate professor of medicine and epidemiology.
Wachter is associate chairman of UCSF's Department of Medicine, chief of the Medical Service at UCSF Medical Center and the study's principal investigator. UCSF Medical Center is part of UCSF Stanford Health Care.
The year-long study, which involved 1,623 patients at UCSF Medical Center from July 1995 to June 1996, showed that patients stayed an average of 4.3 days, at a cost of $7,007, when their care was managed more closely, generally by a hospitalist. They spent 4.9 days, at $7,777, under a more traditional structure. Patients were randomly divided into the two groups.
There was no significant difference between how patients in both groups fared
Contact: Diana Marszalek
University of California - San Francisco