Though more medical centers are relying on hospitalists -- hospital-based internal medicine specialists who coordinate the complex care of inpatients -- a new study suggests that hospitals can safely lower the cost of hospitalist programs without sacrificing quality of care
The 18-month study published in the Journal of Clinical Outcomes Management compared two hospitalist groups -- one with a high physician assistant-to-physician ratio ("expanded PA") and one with a low PA-to-physician ratio ("conventional") -- and found no significant differences in the important clinical outcomes achieved by both groups.
The study saw little difference in patient mortality, hospital readmissions within 30 days, lengths of stay or specialty consultant use among patients treated by the expanded PA group and those treated by the conventional group.
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From January 2012 to June 2013, the researchers implemented an expanded PA staffing model to see larger numbers of adult patients alongside physicians. The expanded PA group consisted of three physicians and three PAs, with PAs caring for 14 patients each day. At the same time, a conventional hospitalist group composed of nine physicians and two PAs had PAs caring for nine patients each day. Physicians in both groups cared for approximately 13 patients a day.
In both groups, each PA was formally paired with a physician who oversaw care. While PAs were responsible for making independent rounds and clinical decision-making, physicians in both groups took primary responsibility of making the rounds for patients with more complex cases. Both groups mandated an in-person physician visit at least every third hospital day.
Patients admitted to the hospital were assigned to one hospitalist group or the other depending on prearranged consultations with patients' primary care physicians.
Each morning, patients were reassessed and designated a provider; patients would be seen by the same provider as the previous day whenever possible to maintain continuity. In the expanded PA group, 35.73 percent of visits were conducted by a PA, compared to 5.89 percent in the conventional group.
The research team compared readmissions within 30 days of discharge, inpatient mortality and costs of care between the two groups as primary outcomes for the study. The team measured the cost of care to patients by examining case charges associated with each caregiver encounter and classifying encounters as "physician only," "physician co-visit" or "PA only."
Consultant use, such as cardiology consultations, and length of stay were also measured.
In the expanded PA group, 14.05 percent of patients (929 of 6,612) were readmitted within 30 days, while 13.69 percent (1,417 of 10,352) in the conventional staffing model were readmitted.