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.
Authors' affiliations: Dean and Professor (Dr Cowan), School of Nursing; Professor and Chief (Dr Shapiro), and Professor of Medicine (Dr Hays), Division of General Internal Medicine and Health Services Research; Dean Emeritus and Professor of Biostatistics (Dr Afifi), School of Public Health; Assistant Clinical Professor (Dr Vazirani), Hospitalist Division, VA Department of Medicine, Department of Medicine; Director of Inpatient Nursing (Dr Ward), UCLA Medical Center; and Professor (Dr Ettner), Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California-Los Angeles, Calif.
Corresponding author: Dr Cowan, School of Nursing, University of California-Los Angeles, PO Box 951702, Los Angeles, CA 90095-1702 (firstname.lastname@example.org).
Funding: Agency for Health Care Policy and Research (1 RO1 HS10734), PI: M. Cowan.