Vascular surgeon-hospitalist comanagement improves in-hospital mortality at the expense of increased in-hospital cost

Tadros, Rami O.; Tardiff, Melissa; Faries, Peter L.; Stoner, Michael C.; Png, C.Y. Maximilian; Kaplan, David; Vouyouka, Ageliki G.; Marin, Michael L.

doi:10.1016/j.jvs.2016.09.042

Cited by 24 publications

(13 citation statements)

References 9 publications

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“…The declined mean difference in hospital charges overtime might be attributed to the increased average case mix index (CMI) [73]. Despite being originally created for calculating hospital costs, CMI has been recently used as an indicator of disease severity and the large volume of comorbidities being treated.…”

Section: Discussionmentioning

confidence: 99%

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Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis

Salim

Elmaraezy

Pamarthy

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Background: Over the past 20 years, hospitalists have assumed a greater portion of healthcare service for hospitalized patients. This was mainly due to reducing the length of stay (LOS) and hospital costs shown by many studies. In contrast, other studies suggested increased cost and resources utilization associated with hospitalist-run care models. Aim: We aimed to provide class 1 evidence regarding the effect of hospitalist-run care models on the efficiency of care and patient satisfaction. Design: Meta-analysis. Methods: Four electronic medical databases were searched to retrieve all relevant studies. Two authors screened titles and abstracts of search results for eligibility according to predefined criteria. Initially eligible studies were screened for full text inclusion. Included studies were reviewed for data on LOS, hospital cost, readmission, mortality, and patient satisfaction. Available data were abstracted and analyzed using Comprehensive Meta-Analysis. Results: Sixty-one studies were included for analysis. The overall effect size favored hospitalist-run care models in terms of LOS (MD = −0.67 day, 95% CI [−0.78, −0.56], p < 0.001). There was no significant difference in terms of hospital cost (MD = $92.1, 95% CI [−910.4, 1094.6], p = 0.86) whereas patient satisfaction was similar or even better in hospitalist compared to non-hospitalist (NH) service. Conclusion: Our analysis showed that hospitalist care is associated with decreased LOS and increased patient satisfaction compared to NH. This indicates an increase in the efficiency of care that does not come at the expense of care quality. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

“…Despite being originally created for calculating hospital costs, CMI has been recently used as an indicator of disease severity and the large volume of comorbidities being treated. Tadros et al argued that the increased cost of hospitalization is expected because of the increased resources required to treat patients with higher CMI [73,74].…”

Section: Discussionmentioning

confidence: 99%

Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis

Salim

Elmaraezy

Pamarthy

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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“…Our study adds to the evidence regarding physician co‐management by including urgently admitted and non‐operative patients, and investigating a general physician‐led model. A hospitalist co‐management model in vascular surgical patients from the USA did not demonstrate decreased LOS, but our intervention was more complex, implementing improvements in geriatric care practices through ‘Eat Walk Engage’. Our findings align with evidence for multidisciplinary delirium prevention interventions in vascular surgery, abdominal surgery and hip fracture populations .…”

Section: Discussionmentioning

confidence: 84%

Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward^*

Mudge

McRae

Donovan

et al. 2020

Internal Medicine Journal

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Background Older vascular surgical patients are at high risk of hospital‐associated complications and prolonged stays. Aims To implement a multidisciplinary co‐management model for older vascular patients and evaluate impact on length of stay (LOS), delirium incidence, functional decline, medical complications and discharge destination. Methods Prospective pre‐post evaluation of a quality improvement intervention, enrolling pre‐intervention (August 2012–January 2013) and post‐intervention cohort (September 2013–March 2014). Participants were consenting patients aged 65 years and over admitted to the vascular surgical ward of a metropolitan teaching hospital for at least 3 days. Intervention was physician‐led co‐management plus a multidisciplinary improvement programme targeting delirium and functional decline. Primary outcomes were LOS, delirium and functional decline. Secondary outcomes were medical complications and discharge destination. Process measures included documented consultation patterns. Administrative data were also compared for all patients aged 65 and older for 12 months pre‐ and post‐intervention. Results We enrolled 112 participants pre‐intervention and 123 participants post‐intervention. LOS was reduced post‐intervention (geometric mean 7.6 days vs 9.3 days; ratio of geometric means 0.82 (95% confidence interval CI0.68–1.00), P = 0.04). There was a trend to less delirium (18 (14.6%) vs 24 (21.4%), P = 0.17) and functional decline (18 (14.6%) vs 27 (24.3%), P = 0.06), with greatest reductions in the urgently admitted subgroup. Administrative data showed reduced median LOS (5.2 days vs 6 days, P = 0.03) and greater discharge home (72% vs 50%, P < 0.01). Conclusions Physician‐led co‐management plus a multidisciplinary improvement programme may reduce LOS and improve functional outcomes in older vascular surgical patients.

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“…Of 6027 articles identified in initial searches, 73 underwent full-text assessment and 16 studies were identified for inclusion, including 1 (6%) RCT, 24 1 (6%) comparative cohort study, 25 and 14 (88%) pre-post studies, 23,[26][27][28][29][30][31][32][33][34][35][36][37][38] 3 (21%) of which included a concurrent control group. 26,32,33 A total of 3 pre-post studies (21%) were conducted at the same site using the same intervention but with different study dates and inclusion criteria, 27,34,35 so we included the study with the longest duration and largest range of outcomes. 27 Study characteristics for the final 14 studies (including 35 800 patients; 13 142 participants [36.7%] in intervention groups and 22 658 participants [63.3%] in control groups) are summarized in Table 1 and details of the structure and process of the interventions in eTable 1 in the Supplement.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of Surgical Patients and Clinical Outcomes

2020

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IMPORTANCE Older patients who undergo surgery may benefit from geriatrician comanagement. It is unclear whether other internal medicine (IM) physician involvement improves outcomes for adults who undergo surgery. OBJECTIVE To evaluate the association of IM physician involvement with clinical and health system outcomes compared with usual surgical care among adults who undergo surgery. DATA SOURCES MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for studies published in English from database inception to April 2, 2019. STUDY SELECTION Prospective randomized or nonrandomized clinical studies comparing IM physician consultation or comanagement with usual surgical care were selected by consensus of 2 reviewers. DATA EXTRACTION AND SYNTHESIS Data were extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline by 2 authors independently. Intervention characteristics were described using existing indicators. Risk of bias was assessed using Risk of Bias 2.0 and Risk of Bias in Nonrandomized Studies of Interventions tools. Studies were pooled when appropriate in meta-analysis using random-effects models. Prespecified subgroups included IM physician-only vs multidisciplinary team interventions and patients undergoing elective vs emergency procedures. MAIN OUTCOMES AND MEASURESThe prespecified primary outcome was length of stay; other outcomes included 30-day readmissions, inpatient mortality, medical complications, functional outcomes, and costs. RESULTSOf 6027 records screened, 14 studies (with 1 randomized clinical trial) involving 35 800 patients (13 142 [36.7%] in intervention groups) were eligible for inclusion. Interventions varied substantially among studies and settings; most interventions described comanagement by a hospitalist or internist; 7 (50%) included a multidisciplinary team, and 9 (64%) studied predominantly patients who had elective procedures. Risk of bias in 10 studies (71%) was serious.

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Vascular surgeon-hospitalist comanagement improves in-hospital mortality at the expense of increased in-hospital cost

Abstract: In-hospital cost is significantly higher since the start of the HCS. This surge may relate to increased CMI, LOS, and improved coding. This increase in cost may be justified as we have observed sustained reduction in in-hospital mortality and slightly improved readmission rates.

Cited by 24 publications

References 9 publications

Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis

Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis

Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward^*

Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of Surgical Patients and Clinical Outcomes

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Vascular surgeon-hospitalist comanagement improves in-hospital mortality at the expense of increased in-hospital cost

Abstract: In-hospital cost is significantly higher since the start of the HCS. This surge may relate to increased CMI, LOS, and improved coding. This increase in cost may be justified as we have observed sustained reduction in in-hospital mortality and slightly improved readmission rates.

Cited by 24 publications

References 9 publications

Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis

Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis

Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward*

Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of Surgical Patients and Clinical Outcomes

Contact Info

Product

Resources

About

Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward^*