UCSF Hospitalists May Be Key To Shorter, Less Costly Hospital Stays

May 19, 1998

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 healthwise, or how satisfied they were with the care they received, Wachter said. That finding is based on a wide range of observations, including patient outcomes and hospital readmissions, as well as a patient survey.

The study also may ease concerns of residents that the increasing involvement of hospitalists could cost them their autonomy and compromise the quality of their education, Wachter said. A survey showed that a majority of residents who worked side-by-side with the hospitalists were highly satisfied with the experience. In fact, the majority preferred it to the traditional system.

Also allayed were the concerns of other specialists, who questioned whether they would get fewer referrals as a result of greater reliance on hospitalists, Wachter said.

The findings, Wachter said, further support the increasingly popular idea of using hospitalists to improve the efficiency, and possibly the quality, of inpatient care. The concept of the dedicated inpatient physician was first described by Wachter and co-author Lee Goldman, MD, UCSF professor of medicine and chair of the UCSF Department of Medicine, in a seminal 1996 New England Journal of Medicine article, in which the term "hospitalist" was coined.

While improving value may not have been a primary focus as little as five years ago, managed care now forces health care providers to look for ways to cut costs without harming quality or patient satisfaction, Wachter said.

"Nearly two years after the study, the practice of having attending physicians being involved sooner and more intensely makes up the majority of the way things work now," Wachter said. "Now these methods are standard procedure."

Co-investigators include Goldman; Patricia Katz, PhD, UCSF assistant professor of medicine; Jonathan Showstack, PhD, MPH, UCSF professor of medicine; and Andrew Bindman, MD, UCSF associate professor of medicine.

University of California - San Francisco

Related Medicine Articles from Brightsurf:

An ultrasonic projector for medicine
A chip-based technology that modulates intensive sound pressure profiles with high resolution opens up new possibilities for ultrasound therapy.

A new discovery in regenerative medicine
An international collaboration involving Monash University and Duke-NUS researchers have made an unexpected world-first stem cell discovery that may lead to new treatments for placenta complications during pregnancy.

How dinosaur research can help medicine
The intervertebral discs connect the vertebrae and give the spine its mobility.

Graduates of family medicine residencies are likely to enter and remain in family medicine
This study provides an overview of the characteristics of physicians who completed family medicine residency training from 1994 to 2017.

Nuclear medicine and COVID-19: New content from The Journal of Nuclear Medicine
In one of five new COVID-19-related articles and commentaries published in the June issue of The Journal of Nuclear Medicine, Johnese Spisso discusses how the UCLA Hospital System has dealt with the pandemic.

Moving beyond 'defensive medicine'
Study shows removing liability concerns slightly increases C-section procedures during childbirth.

NUS Medicine researchers can reprogramme cells to original state for regenerative medicine
Scientists from NUS Medicine have found a way to induce totipotency in embryonic cells that have already matured into pluripotency.

Protein injections in medicine
One day, medical compounds could be introduced into cells with the help of bacterial toxins.

Study reveals complementary medicine use remains hidden to conventional medicine providers
Research reveals that 1 in 3 complementary medicine (CM) users do not disclose their CM use to their medical providers, posing significant direct and indirect risks of adverse effects and harm due to unsafe concurrent use of CM and conventional medicine use.

Study of traditional medicine finds high use in Sub-Saharan Africa despite modern medicine
Researchers who have undertaken the first systematic review of into the use of traditional, complementary and alternative medicines (TCAM) in Sub-Saharan Africa found its use is significant and not just because of a lack of resources or access to 'conventional medicine'.

Read More: Medicine News and Medicine Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.