The Effect of a Multidisciplinary Hospitalist/Physician and Advanced Practice Nurse Collaboration on Hospital Costs

Objective: To compare nurse practitioner/physician management of hospital care, multidisciplinary team-based planning, expedited discharge, and assessment after discharge to usual management. Background: In the context of managed care, the goal of academic medical centers is to provide quality care at the lowest cost and minimize length of stay (LOS) while not compromising quality. Methods: Comparative, 2-group, quasiexperimental design was used; 1,207 general medicine patients (n = 581 in the experimental group and n = 626 in the control group) were enrolled. The control unit provided usual care. The care management in the experimental unit had 3 different components: an advanced practice nurse who followed the patients during hospitalization and 30 days after discharge, a hospitalist medical director and another hospitalist, and daily multidisciplinary rounds. LOS, hospital costs, mortality, and readmission 4 months after discharge were measured. Results: Average LOS was significantly lower for patients in the experimental group than the control group (5 vs. 6 days, P < .0001). The "backfill profit" to the hospital was US$1591 per patient in the experimental group (SE, US$639). There were no significant group differences in mortality or readmissions. Conclusions: Collaborative physician/nurse practitioner multidisciplinary care management of hospitalized medical patients reduced LOS and improved hospital profit without altering readmissions or mortality.

[1]  R. Hays,et al.  An Alternative Approach to Reducing the Costs of Patient Care? A Controlled Trial of the Multi-Disciplinary Doctor-Nurse Practitioner (MDNP) Model , 2006, Medical decision making : an international journal of the Society for Medical Decision Making.

[2]  E. Zink Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. , 2006, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[3]  R. Hays,et al.  Health-related quality of life and patient reports about care outcomes in a multidisciplinary hospital intervention , 2006, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[4]  Nicole A. Lazar,et al.  Statistical Analysis With Missing Data , 2003, Technometrics.

[5]  M. Naylor,et al.  Lessons learned from testing the quality cost model of Advanced Practice Nursing (APN) transitional care. , 2002, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[6]  Mitchel Erickson,et al.  Acute care nurse practitioners: creating and implementing a model of care for an inpatient general medical service. , 2002, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[7]  R. Wachter,et al.  The hospitalist movement 5 years later. , 2002, JAMA.

[8]  G. Braunstein,et al.  The value of a hospitalist service: efficient care for the aging population? , 2001, Chest.

[9]  R. Whitaker,et al.  Evaluation of a Pediatric Hospitalist Service: Impact on Length of Stay and Hospital Charges , 2000, Pediatrics.

[10]  Susan Cohen,et al.  Outcomes of Early Hospital Discharge of Women Undergoing Abdominal Hysterectomy , 2000 .

[11]  M. Naylor,et al.  The effects of a discharge planning and home follow-up intervention on elders hospitalized with common medical and surgical cardiac conditions. , 1999, The Journal of cardiovascular nursing.

[12]  R. Wachter,et al.  The hospitalist movement and its implications for the care of hospitalized children. , 1999, Pediatrics.

[13]  M. Naylor,et al.  Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. , 1999, JAMA.

[14]  R. Wachter An Introduction to the Hospitalist Model , 1999, Annals of Internal Medicine.

[15]  W. Caplan,et al.  Implementation of a Hospitalist System in a Large Health Maintenance Organization: The Kaiser Permanente Experience , 1999, Annals of Internal Medicine.

[16]  R. Freese The Park Nicollet Experience in Establishing a Hospitalist System , 1999, Annals of Internal Medicine.

[17]  J. Janosky,et al.  The Effect of Full-Time Faculty Hospitalists on the Efficiency of Care at a Community Teaching Hospital , 1998, Annals of Internal Medicine.

[18]  S. Sereika,et al.  Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison. , 1998, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[19]  R M Wachter,et al.  Reorganizing an academic medical service: impact on cost, quality, patient satisfaction, and education. , 1998, JAMA.

[20]  A. Swank,et al.  A randomized trial of early discharge and nurse specialist transitional follow-up care of high-risk childbearing women. , 1997, Nursing research.

[21]  R M Wachter,et al.  The emerging role of "hospitalists" in the American health care system. , 1996, The New England journal of medicine.

[22]  S. Finkler,et al.  A Randomized Trial of Early Hospital Discharge and Home Follow-Up of Women Having Cesarean Birth , 1994, Obstetrics and gynecology.

[23]  G. Liptak,et al.  Nurse practitioners' effectiveness in NICU. , 1994, Nursing management.

[24]  W. Greene,et al.  Accounting for Excess Zeros and Sample Selection in Poisson and Negative Binomial Regression Models , 1994 .

[25]  M. Naylor,et al.  Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial. , 1994, Annals of internal medicine.

[26]  Improved quality of care and reduction of housestaff workload using trauma nurse practitioners. , 1990, The Journal of trauma.

[27]  Roderick J. A. Little,et al.  Statistical Analysis with Missing Data , 1988 .

[28]  M. Delivoria-Papadopoulos,et al.  A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants. , 1986, The New England journal of medicine.

[29]  A. Berger FUNDAMENTALS OF BIOSTATISTICS , 1969 .