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A voluntary hospitalist service at a community-based teaching hospital produced reductions in length of stay and costs that became statistically significant in the second year of use. A mortality benefit extending beyond hospitalization was noted in both years. Future investigations are needed to understand the ways in which hospitalists increase clinical efficiency and appear to improve the quality of care.

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At one institution, hospital resource utilization for revision total hip arthroplasty was found to be significantly higher than that for primary arthroplasty. This information is not reflected by current United States Medicare hospital reimbursement, which is the same for all lower-extremity arthroplasty procedures, regardless of the diagnosis, the complexity of the procedure, or the patient's baseline medical health. If these findings are generalizable to other institutions, appropriate reimbursement formulas should be developed to accurately reflect the true costs of caring for patients with a failed total hip arthroplasty.

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Objectives To examine resource use (costs) by women presenting for infertility evaluation and treatment over 18 months, regardless of treatment pursued. Design Prospective cohort study in which women were followed for 18 months. Setting Eight infertility practices. Patients 398 women recruited from infertility practices. Data collection Women completed interviews and questionnaires at baseline, and after 4, 10, and 18 months of follow-up. Medical records were abstracted after 18 months to obtain details of services used. Main outcome measures Per-person and per-successful-outcome costs Results Treatment groups were defined as highest intensity treatment use. 20% of women did not pursue cycle-based treatment; about half pursued in-vitro fertilization (IVF). Median per-person costs ranged from $1,182 for medications only, to $24,373 and $38,015 for IVF and IVF-donor egg groups, respectively. Estimates of costs of successful outcomes (delivery or ongoing pregnancy by 18 months) were higher – $61,377 for IVF, for example – reflecting treatment success rates. Within the timeframe of the study, costs were not significantly different for women who were successful and women who were not. Conclusions While individual patient costs vary, these cost estimates developed from actual patient treatment experiences may provide patients with realistic estimates to consider when initiating infertility treatment.

Objective To determine the effect of income, education, and race on the utilization and outcomes of infertility care. Design Prospective cohort Setting 8 community and academic infertility practices Patients 391 women presenting for an infertility evaluation Interventions Face-to-face and telephone interviews and questionnaires Main Outcome Measures Utilization of infertility services and odds of pregnancy. Linear and logistic regression used to assess relationship between racial and socioeconomic (SES) characteristics, utilization of fertility services, and fertility outcomes. Results After adjustment for age, demographic and fertility characteristics, college-educated couples (β $5,786, p=0.006) and households earning $100,000–$150,000 (β $6,465, p=0.01) and ≥$150,000 (β $8,602, p < 0.001) spent significantly more on fertility care than their non-college-educated, lower income couples. Higher income and college-educated couples were much more likely to utilize more cycles of higher intensity fertility treatment. The increased cost of fertility care was primarily explained by these differences in number and type of fertility treatment. Even after adjustment for these factors and total amount spent on fertility care, having a college degree was associated with persistently higher odds of achieving a pregnancy (OR 1.9, p=0.02). Conclusions Education and household income were independently associated with the amount of money spent on fertility care. This relationship was primarily explained by types and intensity of fertility treatments used. Having at least a college degree was independently associated with improved odds of pregnancy.