The effects of a hospitalist comanagement model for joint arthroplasty patients in a teaching facility

Duplantier, Neil L., Briski, David C., Luce, Lindsay T., Meyer, Mark S., Ochsner, John L. and Chimento, George F. (2016) The effects of a hospitalist comanagement model for joint arthroplasty patients in a teaching facility. Journal of Arthroplasty, 31 3: 567-572. doi:10.1016/j.arth.2015.10.010

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Author Duplantier, Neil L.
Briski, David C.
Luce, Lindsay T.
Meyer, Mark S.
Ochsner, John L.
Chimento, George F.
Title The effects of a hospitalist comanagement model for joint arthroplasty patients in a teaching facility
Journal name Journal of Arthroplasty   Check publisher's open access policy
ISSN 1532-8406
0883-5403
Publication date 2016-03-01
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.arth.2015.10.010
Open Access Status File (Author Post-print)
Volume 31
Issue 3
Start page 567
End page 572
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Churchill Livingstone
Language eng
Abstract The goal of this study was to compare postoperative medical comanagement of total hip arthroplasty and total knee arthroplasty patients using a hospitalist (H) and nonhospitalist (NH) model at a single teaching institution to determine the clinical and economic impact of the hospitalist comanagement.

We retrospectively reviewed the records of 1656 patients who received hospitalist comanagement with 1319 patients who did not. The NH and H cohorts were compared at baseline via chi-square test for the American Society of Anesthesiologists classification, the t test for age, and the Wilcoxon test for the unadjusted Charlson Comorbidity Index score and the age-adjusted Charlson Comorbidity Index score. Chi-square test was used to compare the postoperative length of stay, readmission rate at 30 days after surgery, diagnoses present on admission, new diagnoses during admission, tests ordered postoperatively, total direct cost, and discharge location.

The H cohort gained more new diagnoses (P < .001), had more studies ordered (P < .001), had a higher cost of hospitalization (P = .002), and were more likely to be discharged to a skilled nursing facility (P < .001). The H cohort also had a lower length of stay (P < .001), but we believe evolving techniques in both pain control and blood management likely influenced this. There was no significant difference in readmissions.

Any potential benefit of a hospitalist comanagement model for this patient population may be outweighed by increased cost.
Formatted abstract
Background: The goal of this study was to compare postoperative medical comanagement of total hip arthroplasty and total knee arthroplasty patients using a hospitalist (H) and nonhospitalist (NH) model at a single teaching institution to determine the clinical and economic impact of the hospitalist comanagement.
Methods: We retrospectively reviewed the records of 1656 patients who received hospitalist comanagement with 1319 patients who did not. The NH and H cohorts were compared at baseline via chi-square test for the American Society of Anesthesiologists classification, the t test for age, and the Wilcoxon test for the unadjusted Charlson Comorbidity Index score and the age-adjusted Charlson Comorbidity Index score. Chi-square test was used to compare the postoperative length of stay, readmission rate at 30 days after surgery, diagnoses present on admission, new diagnoses during admission, tests ordered postoperatively, total direct cost, and discharge location.
Results: The H cohort gained more new diagnoses (P < .001), had more studies ordered (P < .001), had a higher cost of hospitalization (P = .002), and were more likely to be discharged to a skilled nursing facility (P < .001). The H cohort also had a lower length of stay (P < .001), but we believe evolving techniques in both pain control and blood management likely influenced this. There was no significant difference in readmissions.
Conclusion: Any potential benefit of a hospitalist comanagement model for this patient population may be outweighed by increased cost.
Keyword Arthroplasty
Cost
Hip
Hospitalist
Knee
Risk adjustment
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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