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Surgical Comanagement by Hospitalists Improves Patient Outcomes: A Propensity Score Analysis

Rohatgi, Nidhi MD, MS; Loftus, Pooja MS; Grujic, Olgica; Cullen, Mark MD; Hopkins, Joseph MD, MMM; Ahuja, Neera MD

doi: 10.1097/SLA.0000000000001629
Original Articles

Objective: The aim of the study was to examine the impact of a surgical comanagement (SCM) hospitalist program on patient outcomes at an academic institution.

Background: Prior studies may have underestimated the impact of SCM due to methodological shortcomings.

Methods: This is a retrospective study utilizing a propensity score-weighted intervention (n = 16,930) and control group (n = 3695). Patients were admitted between January 2009 to July 2012 (pre-SCM) and September 2012 to September 2013 (post-SCM) to Orthopedic or Neurosurgery at our institution. Using propensity score methods, linear regression, and a difference-in-difference approach, we estimated changes in outcomes between pre and post periods, while adjusting for confounding patient characteristics.

Results: The SCM intervention was associated with a significant differential decrease in the proportion of patients with at least 1 medical complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.74–0.96; P = 0.008), the proportion of patients with length of stay at least 5 days (OR 0.75; 95% CI, 0.67–0.84; P < 0.001), 30-day readmission rate for medical cause (OR 0.67; 95% CI, 0.52–0.81; P < 0.001), and the proportion of patients with at least 2 medical consultants (OR 0.55; 95% CI, 0.49–0.63; P < 0.001). There was no significant change in patient satisfaction (OR 1.08; 95% CI, 0.87–1.33; P = 0.507). We estimated average savings of $2642 to $4303 per patient in the post-SCM group. The overall provider satisfaction with SCM was 88.3%.

Conclusions: The SCM intervention reduces medical complications, length of stay, 30-day readmissions, number of consultants, and cost of care.

*Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, CA

Department of Quality, Patient Safety, and Clinical Effectiveness, Stanford Health Care, CA.

Reprints: Nidhi Rohatgi, MD, 300 Pasteur Drive, HCO32D, Mail Code 5278, Stanford, CA 94305. E-mail: nrohatgi@stanford.edu

Conflicts of interest: None declared by any of the authors.

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