Setting

SGH is the largest acute tertiary care hospital in Singapore. It has 29 clinical departments many of which are established as national referral centers. It has 1600‐beds in Singapore, serving approximately one‐fourth of its population of 4.59 million.15 It is affiliated with the Yong Loo Lin School of Medicine at the National University of Singapore (NUS) and the Duke‐NUS Graduate Medical School. Forty‐eight percent of the medical staff hold teaching appointments. It is also a major training hospital for residents, accounting for approximately 60% of the total amount of residency training in Singapore.

Intervention

In May 2006, a clinical family medicine department was established in the Singapore General Hospital with the intention of developing a local adaptation of the hospitalist care model.16 The important distinctive features of the adapted hospitalist model as compared to the model commonly found in North America include:

• 1

  All attending physicians in the hospitalist teams are family physicians by training. The family medicine training program in Singapore resembles a hospital based residency program in the United States. It comprises a minimum of 2 years of structured training based in an acute hospital and 1 year in a primary care setting. The attending physicians in the hospitalist program spend a minimum of 25% of their time providing general medical care for hospitalized patients. The average time spent in inpatient care by the attending physicians was 33%(unpublished internal data). The rest of the time, they are rotated to run hospital‐based ambulatory care clinics, preoperative evaluation clinics, health assessment clinics and a home‐based intermediate care service. All the attending physicians hold teaching appointments and are involved in the teaching of medical students and residents.

• 2

  Bringing family physicians into the hospital. In Singapore as it is in many health system modeled after the British system, internists work almost exclusively in the hospitals while primary care is almost exclusively provided for by family physicians who are referred to as GP. Primary physicians in Singapore do not have a tradition of managing their patients after admission to the hospital. The pace of specialization of medicine intensified after the mid‐1980s when all public hospitals in Singapore were restructured. The number of full‐time general internist dwindled dramatically and presently general medical care of patients in most hospitals in Singapore are provided for mainly by specialists.17 There had been criticism of the hospitalist care model in the United States for introducing care discontinuity between the hospital and the community.18, 19 Unlike the situation in the United States, the use of family physicians as hospitalist in Singapore is seen as a disruption of a different kind of tradition where there is a distinct divide between physicians who care for patients in the community and those who care for patients in the hospital setting.

• 3

  Discharged patients with unresolved issues are followed up by the family medicine hospitalist at the ambulatory care clinics in the hospital. Patients are reviewed until they can be handed off to suitable health care providers in the community, to continue with their long term care outside the hospital. Specialist physicians of the hospital provide a similar system of follow‐up of discharged patients although they are more likely to be referred for review by different specialties according to the patients' comorbidities.

Traditionally, patients who are admitted to the Singapore General Hospital come under the care of single system specialists. Many of them are subspecialists who spend a large part of their time running specialist outpatient services and performing procedures and interventions related to their specialty. Approximately 66% of cases admitted from the emergency department to be cared for by the medical departments require specialty care and are admitted directly to the specialist departments. The rest of the patients (34%) are admitted under the category of internal medicine. The admitting physicians who work in Department of Emergency Medicine make these decisions independently. All physicians from the medical specialty departments go on a roster to provide general medical care for such patients usually with the help of specialist consultations. The reason for this form of usual care is again historically related to the fact that the Singapore health system was developed and modeled after the British system.

Patients admitted under the category of internal medicine were assigned hospital beds based on availability of beds for this category of admissions by the bed management unit of the hospital. A total of 34 beds out of 232 beds that are available for use under this category of admission are assigned to be cared for by the family medicine hospitalists in this program. The assignment is administrative and these beds are no different from other beds that accept patients admitted under the same admission category. The assignment of patients to the family medicine hospitalist or the specialist is therefore determined by the bed availability at the time of admission.

Data Source

Data of all hospitalized patients aged 18 years and above who were admitted into the Singapore General Hospital from January 1, 2008 to December 31, 2008 were collected from the hospital data warehouse at the Information Technology Department, SingHealth Group, Singapore. The collected data included demographic information such as ethnic group, gender, age, marital status, admission date, discharge date, intensive care unit (ICU) admission, disease codes under ICD‐9‐AM (International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification), and ICD‐9‐AM procedure codes. Data of patients who were readmitted to the hospital within 30‐days after the first discharge were also extracted. Available cost of care data including investigation, medication, treatment, and facility charges were also extracted based on hospital service codes. The protocol was approved by the Ethics Committee of the Singapore General Hospital with exemption from the requirement for informed consent.

Case Definition

Patients cared for by hospitalists were inpatients who were under the care of attending physicians from the Department of Family Medicine and Continuing Care using the adapted hospitalist care model. Patients cared for by nonhospitalists who were inpatients and who were cared for by all other attending specialist physicians from the other medical departments go on a roster to provide general medical care under the usual care model.

Surgical and medical conditions were determined based on the presence of ICD‐9‐AM diagnostic codes and procedure codes.20

Chronic comorbid conditions were identified by ICD‐9‐AM codes and were then studied using the Charlson Index.2123 The Charlson score was then classified into 4 previously defined grades known as the Charlson Comorbidity Index (CCI): 0 points (none), 1 to 2 points (low), 3 to 4 points (moderate), and 5 points (high).2123

Organ failure was defined by a combination of ICD‐9‐AM diagnosis and procedure codes, as outlined previously.24, 25

Statistical Analysis

Categorical variables were reported as percentages, continuous variables were reported as mean and standard deviation (SD). Hospital LOS and hospitalization cost of care were reported using geometric mean (GM) and 95% confidence interval (CI) because of their skewed distribution.

Hospital mortality rate was defined as the ratio of inpatient deaths to the total number of inpatients. Age was categorized into quintiles (18‐54, 55‐64, 65‐74, 75‐84, and >84 years) to capture the nonlinear effect of age on hospital service quality and resource utilization. Parameters were compared between patients cared for by hospitalists and nonhospitalists by chi‐square test for hospital mortality and readmission rate and by Mann‐Whitney U test for LOS and hospital cost. All hospital costs were converted to the year 2008 US dollars for presentation based on the Annual Average Rates of Exchange, Singapore (2008).26 Logistic regression was used to assess the association of hospital mortality and 30‐day all‐cause unscheduled readmission after adjusting for gender, ethnic group, ICU admission, CCI groups, number of organ failures, and the interaction among age groups, CCI groups, and numbers of organ failures. Analysis of hospital LOS and hospitalization costs were restricted to cases with values within 3 SD of the mean because of the extremely skewed nature of these data. Generalized linear model was used to assess log‐transformed LOS and cost with hospitalists care and adjusted for the above‐mentioned factors. The HosmerLemeshow chi‐square goodness‐of‐fit tests were used to exclude variables and identify clinically plausible interaction terms. Using the estimates from the regression models, we presented differences in adjusted LOS, hospitalization costs, hospital mortality, and 30‐day all‐cause unscheduled readmission between hospitalists and nonhospitalists. All P values were 2 sided. The level of statistical significance was considered to be the conventional alpha = 0.05. The data analysis was performed with SPSS 17.0 software (SPSS, Chicago, IL).

Unadjusted Clinical Outcomes and Resource Utilization

The in‐hospital mortality rates in patients cared for by hospitalists were similar (4.0% vs. 5.3%, P= 0.187) compared to patients cared for by nonhospitalists (Table 2). Also, there were no statistically significant differences in the 30‐day all‐cause unscheduled readmission rates between patients cared for by hospitalists and nonhospitalists (7.5% vs. 7.3%, p= 0.854). As for resource utilization, patients cared for by hospitalists had significantly shorter hospital LOS (GM, 4.6 vs. 5.7 days, P < 0.001) and lower cost (GM, $2301.0 vs. $2656.6, P= 0.001) compared with that in patients cared for by nonhospitalists (Table 2).

Adjusted (Multivariate) Results of Hospital Clinical Outcomes and Resource Utilization

Multivariate analysis was used with adjustment for age groups, ethnic group, gender, ICU admission, numbers of organ failures, and CCI grades. Patients cared for by hospitalists, as compared with patients cared for by nonhospitalists, had a statistically significant shorter hospital LOS by 0.9 days (GM, 4.4 vs. 5.3 days, P < 0.001) and lower cost by $250 (GM, $2250.7 vs. $2500.0, P= 0.003), but similar in‐hospital mortality and 30‐day all‐cause readmission rates (both P > 0.05; Table 2). The goodness of fit of the regression model used for hospital LOS was assessed with the Hosmer‐Lemeshow test (2= 546.1, degree of freedom (df) = 3406, P= 0.160).

As for the detailed secondary cost, patients cared for by hospitalists had significantly lower treatment costs by $66 (GM, $462.9 vs. $528.1 P < 0.001) and facility costs by $127 (GM, $827.1 vs. $953.7 P < 0.001) compared with patients cared for by nonhospitalists after adjustment for age groups, ethnic group, gender, ICU admission, presence of organ failures, and CCI grades. The investigation and medication costs were comparable between the 2 groups (all P > 0.05) even after similar adjustments (Table 3).

Setting

SGH is the largest acute tertiary care hospital in Singapore. It has 29 clinical departments many of which are established as national referral centers. It has 1600‐beds in Singapore, serving approximately one‐fourth of its population of 4.59 million.15 It is affiliated with the Yong Loo Lin School of Medicine at the National University of Singapore (NUS) and the Duke‐NUS Graduate Medical School. Forty‐eight percent of the medical staff hold teaching appointments. It is also a major training hospital for residents, accounting for approximately 60% of the total amount of residency training in Singapore.

Intervention

In May 2006, a clinical family medicine department was established in the Singapore General Hospital with the intention of developing a local adaptation of the hospitalist care model.16 The important distinctive features of the adapted hospitalist model as compared to the model commonly found in North America include:

• 1

  All attending physicians in the hospitalist teams are family physicians by training. The family medicine training program in Singapore resembles a hospital based residency program in the United States. It comprises a minimum of 2 years of structured training based in an acute hospital and 1 year in a primary care setting. The attending physicians in the hospitalist program spend a minimum of 25% of their time providing general medical care for hospitalized patients. The average time spent in inpatient care by the attending physicians was 33%(unpublished internal data). The rest of the time, they are rotated to run hospital‐based ambulatory care clinics, preoperative evaluation clinics, health assessment clinics and a home‐based intermediate care service. All the attending physicians hold teaching appointments and are involved in the teaching of medical students and residents.

• 2

  Bringing family physicians into the hospital. In Singapore as it is in many health system modeled after the British system, internists work almost exclusively in the hospitals while primary care is almost exclusively provided for by family physicians who are referred to as GP. Primary physicians in Singapore do not have a tradition of managing their patients after admission to the hospital. The pace of specialization of medicine intensified after the mid‐1980s when all public hospitals in Singapore were restructured. The number of full‐time general internist dwindled dramatically and presently general medical care of patients in most hospitals in Singapore are provided for mainly by specialists.17 There had been criticism of the hospitalist care model in the United States for introducing care discontinuity between the hospital and the community.18, 19 Unlike the situation in the United States, the use of family physicians as hospitalist in Singapore is seen as a disruption of a different kind of tradition where there is a distinct divide between physicians who care for patients in the community and those who care for patients in the hospital setting.

• 3

  Discharged patients with unresolved issues are followed up by the family medicine hospitalist at the ambulatory care clinics in the hospital. Patients are reviewed until they can be handed off to suitable health care providers in the community, to continue with their long term care outside the hospital. Specialist physicians of the hospital provide a similar system of follow‐up of discharged patients although they are more likely to be referred for review by different specialties according to the patients' comorbidities.

Traditionally, patients who are admitted to the Singapore General Hospital come under the care of single system specialists. Many of them are subspecialists who spend a large part of their time running specialist outpatient services and performing procedures and interventions related to their specialty. Approximately 66% of cases admitted from the emergency department to be cared for by the medical departments require specialty care and are admitted directly to the specialist departments. The rest of the patients (34%) are admitted under the category of internal medicine. The admitting physicians who work in Department of Emergency Medicine make these decisions independently. All physicians from the medical specialty departments go on a roster to provide general medical care for such patients usually with the help of specialist consultations. The reason for this form of usual care is again historically related to the fact that the Singapore health system was developed and modeled after the British system.

Patients admitted under the category of internal medicine were assigned hospital beds based on availability of beds for this category of admissions by the bed management unit of the hospital. A total of 34 beds out of 232 beds that are available for use under this category of admission are assigned to be cared for by the family medicine hospitalists in this program. The assignment is administrative and these beds are no different from other beds that accept patients admitted under the same admission category. The assignment of patients to the family medicine hospitalist or the specialist is therefore determined by the bed availability at the time of admission.

Data Source

Data of all hospitalized patients aged 18 years and above who were admitted into the Singapore General Hospital from January 1, 2008 to December 31, 2008 were collected from the hospital data warehouse at the Information Technology Department, SingHealth Group, Singapore. The collected data included demographic information such as ethnic group, gender, age, marital status, admission date, discharge date, intensive care unit (ICU) admission, disease codes under ICD‐9‐AM (International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification), and ICD‐9‐AM procedure codes. Data of patients who were readmitted to the hospital within 30‐days after the first discharge were also extracted. Available cost of care data including investigation, medication, treatment, and facility charges were also extracted based on hospital service codes. The protocol was approved by the Ethics Committee of the Singapore General Hospital with exemption from the requirement for informed consent.

Case Definition

Patients cared for by hospitalists were inpatients who were under the care of attending physicians from the Department of Family Medicine and Continuing Care using the adapted hospitalist care model. Patients cared for by nonhospitalists who were inpatients and who were cared for by all other attending specialist physicians from the other medical departments go on a roster to provide general medical care under the usual care model.

Surgical and medical conditions were determined based on the presence of ICD‐9‐AM diagnostic codes and procedure codes.20

Chronic comorbid conditions were identified by ICD‐9‐AM codes and were then studied using the Charlson Index.2123 The Charlson score was then classified into 4 previously defined grades known as the Charlson Comorbidity Index (CCI): 0 points (none), 1 to 2 points (low), 3 to 4 points (moderate), and 5 points (high).2123

Organ failure was defined by a combination of ICD‐9‐AM diagnosis and procedure codes, as outlined previously.24, 25

Statistical Analysis

Categorical variables were reported as percentages, continuous variables were reported as mean and standard deviation (SD). Hospital LOS and hospitalization cost of care were reported using geometric mean (GM) and 95% confidence interval (CI) because of their skewed distribution.

Hospital mortality rate was defined as the ratio of inpatient deaths to the total number of inpatients. Age was categorized into quintiles (18‐54, 55‐64, 65‐74, 75‐84, and >84 years) to capture the nonlinear effect of age on hospital service quality and resource utilization. Parameters were compared between patients cared for by hospitalists and nonhospitalists by chi‐square test for hospital mortality and readmission rate and by Mann‐Whitney U test for LOS and hospital cost. All hospital costs were converted to the year 2008 US dollars for presentation based on the Annual Average Rates of Exchange, Singapore (2008).26 Logistic regression was used to assess the association of hospital mortality and 30‐day all‐cause unscheduled readmission after adjusting for gender, ethnic group, ICU admission, CCI groups, number of organ failures, and the interaction among age groups, CCI groups, and numbers of organ failures. Analysis of hospital LOS and hospitalization costs were restricted to cases with values within 3 SD of the mean because of the extremely skewed nature of these data. Generalized linear model was used to assess log‐transformed LOS and cost with hospitalists care and adjusted for the above‐mentioned factors. The HosmerLemeshow chi‐square goodness‐of‐fit tests were used to exclude variables and identify clinically plausible interaction terms. Using the estimates from the regression models, we presented differences in adjusted LOS, hospitalization costs, hospital mortality, and 30‐day all‐cause unscheduled readmission between hospitalists and nonhospitalists. All P values were 2 sided. The level of statistical significance was considered to be the conventional alpha = 0.05. The data analysis was performed with SPSS 17.0 software (SPSS, Chicago, IL).

Unadjusted Clinical Outcomes and Resource Utilization

The in‐hospital mortality rates in patients cared for by hospitalists were similar (4.0% vs. 5.3%, P= 0.187) compared to patients cared for by nonhospitalists (Table 2). Also, there were no statistically significant differences in the 30‐day all‐cause unscheduled readmission rates between patients cared for by hospitalists and nonhospitalists (7.5% vs. 7.3%, p= 0.854). As for resource utilization, patients cared for by hospitalists had significantly shorter hospital LOS (GM, 4.6 vs. 5.7 days, P < 0.001) and lower cost (GM, $2301.0 vs. $2656.6, P= 0.001) compared with that in patients cared for by nonhospitalists (Table 2).

Adjusted (Multivariate) Results of Hospital Clinical Outcomes and Resource Utilization

Multivariate analysis was used with adjustment for age groups, ethnic group, gender, ICU admission, numbers of organ failures, and CCI grades. Patients cared for by hospitalists, as compared with patients cared for by nonhospitalists, had a statistically significant shorter hospital LOS by 0.9 days (GM, 4.4 vs. 5.3 days, P < 0.001) and lower cost by $250 (GM, $2250.7 vs. $2500.0, P= 0.003), but similar in‐hospital mortality and 30‐day all‐cause readmission rates (both P > 0.05; Table 2). The goodness of fit of the regression model used for hospital LOS was assessed with the Hosmer‐Lemeshow test (2= 546.1, degree of freedom (df) = 3406, P= 0.160).

As for the detailed secondary cost, patients cared for by hospitalists had significantly lower treatment costs by $66 (GM, $462.9 vs. $528.1 P < 0.001) and facility costs by $127 (GM, $827.1 vs. $953.7 P < 0.001) compared with patients cared for by nonhospitalists after adjustment for age groups, ethnic group, gender, ICU admission, presence of organ failures, and CCI grades. The investigation and medication costs were comparable between the 2 groups (all P > 0.05) even after similar adjustments (Table 3).

Setting

SGH is the largest acute tertiary care hospital in Singapore. It has 29 clinical departments many of which are established as national referral centers. It has 1600‐beds in Singapore, serving approximately one‐fourth of its population of 4.59 million.15 It is affiliated with the Yong Loo Lin School of Medicine at the National University of Singapore (NUS) and the Duke‐NUS Graduate Medical School. Forty‐eight percent of the medical staff hold teaching appointments. It is also a major training hospital for residents, accounting for approximately 60% of the total amount of residency training in Singapore.

Intervention

In May 2006, a clinical family medicine department was established in the Singapore General Hospital with the intention of developing a local adaptation of the hospitalist care model.16 The important distinctive features of the adapted hospitalist model as compared to the model commonly found in North America include:

• 1

  All attending physicians in the hospitalist teams are family physicians by training. The family medicine training program in Singapore resembles a hospital based residency program in the United States. It comprises a minimum of 2 years of structured training based in an acute hospital and 1 year in a primary care setting. The attending physicians in the hospitalist program spend a minimum of 25% of their time providing general medical care for hospitalized patients. The average time spent in inpatient care by the attending physicians was 33%(unpublished internal data). The rest of the time, they are rotated to run hospital‐based ambulatory care clinics, preoperative evaluation clinics, health assessment clinics and a home‐based intermediate care service. All the attending physicians hold teaching appointments and are involved in the teaching of medical students and residents.

• 2

  Bringing family physicians into the hospital. In Singapore as it is in many health system modeled after the British system, internists work almost exclusively in the hospitals while primary care is almost exclusively provided for by family physicians who are referred to as GP. Primary physicians in Singapore do not have a tradition of managing their patients after admission to the hospital. The pace of specialization of medicine intensified after the mid‐1980s when all public hospitals in Singapore were restructured. The number of full‐time general internist dwindled dramatically and presently general medical care of patients in most hospitals in Singapore are provided for mainly by specialists.17 There had been criticism of the hospitalist care model in the United States for introducing care discontinuity between the hospital and the community.18, 19 Unlike the situation in the United States, the use of family physicians as hospitalist in Singapore is seen as a disruption of a different kind of tradition where there is a distinct divide between physicians who care for patients in the community and those who care for patients in the hospital setting.

• 3

  Discharged patients with unresolved issues are followed up by the family medicine hospitalist at the ambulatory care clinics in the hospital. Patients are reviewed until they can be handed off to suitable health care providers in the community, to continue with their long term care outside the hospital. Specialist physicians of the hospital provide a similar system of follow‐up of discharged patients although they are more likely to be referred for review by different specialties according to the patients' comorbidities.

Traditionally, patients who are admitted to the Singapore General Hospital come under the care of single system specialists. Many of them are subspecialists who spend a large part of their time running specialist outpatient services and performing procedures and interventions related to their specialty. Approximately 66% of cases admitted from the emergency department to be cared for by the medical departments require specialty care and are admitted directly to the specialist departments. The rest of the patients (34%) are admitted under the category of internal medicine. The admitting physicians who work in Department of Emergency Medicine make these decisions independently. All physicians from the medical specialty departments go on a roster to provide general medical care for such patients usually with the help of specialist consultations. The reason for this form of usual care is again historically related to the fact that the Singapore health system was developed and modeled after the British system.

Patients admitted under the category of internal medicine were assigned hospital beds based on availability of beds for this category of admissions by the bed management unit of the hospital. A total of 34 beds out of 232 beds that are available for use under this category of admission are assigned to be cared for by the family medicine hospitalists in this program. The assignment is administrative and these beds are no different from other beds that accept patients admitted under the same admission category. The assignment of patients to the family medicine hospitalist or the specialist is therefore determined by the bed availability at the time of admission.

Data Source

Data of all hospitalized patients aged 18 years and above who were admitted into the Singapore General Hospital from January 1, 2008 to December 31, 2008 were collected from the hospital data warehouse at the Information Technology Department, SingHealth Group, Singapore. The collected data included demographic information such as ethnic group, gender, age, marital status, admission date, discharge date, intensive care unit (ICU) admission, disease codes under ICD‐9‐AM (International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification), and ICD‐9‐AM procedure codes. Data of patients who were readmitted to the hospital within 30‐days after the first discharge were also extracted. Available cost of care data including investigation, medication, treatment, and facility charges were also extracted based on hospital service codes. The protocol was approved by the Ethics Committee of the Singapore General Hospital with exemption from the requirement for informed consent.

Case Definition

Patients cared for by hospitalists were inpatients who were under the care of attending physicians from the Department of Family Medicine and Continuing Care using the adapted hospitalist care model. Patients cared for by nonhospitalists who were inpatients and who were cared for by all other attending specialist physicians from the other medical departments go on a roster to provide general medical care under the usual care model.

Surgical and medical conditions were determined based on the presence of ICD‐9‐AM diagnostic codes and procedure codes.20

Chronic comorbid conditions were identified by ICD‐9‐AM codes and were then studied using the Charlson Index.2123 The Charlson score was then classified into 4 previously defined grades known as the Charlson Comorbidity Index (CCI): 0 points (none), 1 to 2 points (low), 3 to 4 points (moderate), and 5 points (high).2123

Organ failure was defined by a combination of ICD‐9‐AM diagnosis and procedure codes, as outlined previously.24, 25

Statistical Analysis

Categorical variables were reported as percentages, continuous variables were reported as mean and standard deviation (SD). Hospital LOS and hospitalization cost of care were reported using geometric mean (GM) and 95% confidence interval (CI) because of their skewed distribution.

Hospital mortality rate was defined as the ratio of inpatient deaths to the total number of inpatients. Age was categorized into quintiles (18‐54, 55‐64, 65‐74, 75‐84, and >84 years) to capture the nonlinear effect of age on hospital service quality and resource utilization. Parameters were compared between patients cared for by hospitalists and nonhospitalists by chi‐square test for hospital mortality and readmission rate and by Mann‐Whitney U test for LOS and hospital cost. All hospital costs were converted to the year 2008 US dollars for presentation based on the Annual Average Rates of Exchange, Singapore (2008).26 Logistic regression was used to assess the association of hospital mortality and 30‐day all‐cause unscheduled readmission after adjusting for gender, ethnic group, ICU admission, CCI groups, number of organ failures, and the interaction among age groups, CCI groups, and numbers of organ failures. Analysis of hospital LOS and hospitalization costs were restricted to cases with values within 3 SD of the mean because of the extremely skewed nature of these data. Generalized linear model was used to assess log‐transformed LOS and cost with hospitalists care and adjusted for the above‐mentioned factors. The HosmerLemeshow chi‐square goodness‐of‐fit tests were used to exclude variables and identify clinically plausible interaction terms. Using the estimates from the regression models, we presented differences in adjusted LOS, hospitalization costs, hospital mortality, and 30‐day all‐cause unscheduled readmission between hospitalists and nonhospitalists. All P values were 2 sided. The level of statistical significance was considered to be the conventional alpha = 0.05. The data analysis was performed with SPSS 17.0 software (SPSS, Chicago, IL).

Unadjusted Clinical Outcomes and Resource Utilization

The in‐hospital mortality rates in patients cared for by hospitalists were similar (4.0% vs. 5.3%, P= 0.187) compared to patients cared for by nonhospitalists (Table 2). Also, there were no statistically significant differences in the 30‐day all‐cause unscheduled readmission rates between patients cared for by hospitalists and nonhospitalists (7.5% vs. 7.3%, p= 0.854). As for resource utilization, patients cared for by hospitalists had significantly shorter hospital LOS (GM, 4.6 vs. 5.7 days, P < 0.001) and lower cost (GM, $2301.0 vs. $2656.6, P= 0.001) compared with that in patients cared for by nonhospitalists (Table 2).

Adjusted (Multivariate) Results of Hospital Clinical Outcomes and Resource Utilization

Multivariate analysis was used with adjustment for age groups, ethnic group, gender, ICU admission, numbers of organ failures, and CCI grades. Patients cared for by hospitalists, as compared with patients cared for by nonhospitalists, had a statistically significant shorter hospital LOS by 0.9 days (GM, 4.4 vs. 5.3 days, P < 0.001) and lower cost by $250 (GM, $2250.7 vs. $2500.0, P= 0.003), but similar in‐hospital mortality and 30‐day all‐cause readmission rates (both P > 0.05; Table 2). The goodness of fit of the regression model used for hospital LOS was assessed with the Hosmer‐Lemeshow test (2= 546.1, degree of freedom (df) = 3406, P= 0.160).

As for the detailed secondary cost, patients cared for by hospitalists had significantly lower treatment costs by $66 (GM, $462.9 vs. $528.1 P < 0.001) and facility costs by $127 (GM, $827.1 vs. $953.7 P < 0.001) compared with patients cared for by nonhospitalists after adjustment for age groups, ethnic group, gender, ICU admission, presence of organ failures, and CCI grades. The investigation and medication costs were comparable between the 2 groups (all P > 0.05) even after similar adjustments (Table 3).