Can Hospitalist Co-management Services Improve Patient Outcomes?

A study of a hospitalist comanagement service for neurosurgery found that while providers perceived a higher quality of care, patient outcomes didn't improve.

Implementation of a hospitalist comanagement service for neurosurgery at the University of California, San Francisco, appeared to reduce costs and improve care quality, but had little impact on patient outcomes or satisfaction, according to research published in the Archives of Internal Medicine.

In the study, Andrew D. Auerbach, MD, MPH, and colleagues analyzed data from adults admitted to a neurosurgery service at UCSF between June 2005 and December 2008 to determine the effects of shared management of surgical patients between surgeons and hospitalists (co-management), a practice that has become “increasingly common.”

Investigators collected data on length of stay, costs, inpatient mortality rate, and 30-day readmission rate from administrative sources, and assessed patient and caregiver satisfaction through surveys. Multivariable models were utilized to estimate the effect of co-management on key outcomes after adjusting for secular trends and patient-specific risk factors.

During the study period, 7,596 patients were admitted to the neurosurgery service: 4,203 (55.3%) before July 2007, and 3,393 (44.7%) after co-management began. Of those admitted during the post-implementation period, 29.1% were co-managed. After co-management was initiated, no differences were found in patient mortality rate, readmission, or length of stay, the authors wrote. No consistent improvements were seen in patient satisfaction; however, nurses and non-nurse health care professionals reported “strong perceived improvements” in care quality. In addition, a reduction of $1,439 per mission was observed.

Because implementation of a hospitalist co-management service had little effect on patient outcomes or satisfaction, the authors recommend placing more emphasis on developing systems that improve patient outcomes as co-management models are adopted.

In an accompanying editorial, Patrick G. O’Malley, MD, MPH, argued that co-management is being driven by economic factors that are shifting care from highly-paid surgeons to lower-paid internists.

“Much of the way our profession evolves seems to be excessively influenced by reaction to economic forces rather than proactive planning with sufficient input from the perspectives of all appropriate stakeholders,” he wrote. “Such is the case with workforce planning in medicine. No doubt, economic forces are the principal factors that influence how we should plan because resources should be allocated commensurate with value. However, this mentality assumes we have a rational system that closely links financing with value. We do not have such a system. In the meantime, I wonder whether we can do better in planning our workforce and practice patterns rather than reacting in a manner so dependent on economic winds.”

To read the study, click here.

Implementing a hospitalist co-management service can reduce costs, but if there is no impact on patient outcomes or satisfaction, is it worth the hassle? What do you feel are the biggest advantages and risks with such a program?