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PEDIATRICS Vol. 110 No. 4 October 2002, pp. 720-728

Impact of a Health Maintenance Organization Hospitalist System in Academic Pediatrics

Christopher P. Landrigan, MD, MPH*, Rajendu Srivastava, MD, MPHast;,{ddagger}, Sharon Muret-Wagstaff, PhD*, Stephen B. Soumerai, ScD§, Dennis Ross-Degnan, PhD§, John W. Graef, MD*,||, Charles J. Homer, MD, MPH* and Donald A. Goldmann, MD*

* Department of Medicine, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
{ddagger} Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah
§ Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
|| Harvard Vanguard Medical Associates, Boston, Massachusetts

--> Objective. Hospitalist systems decrease length of stay (LOS) and cost for hospitalized adults. Whether hospitalist systems decrease LOS and cost for hospitalized children has not been conclusively established. We wanted to determine whether a health maintenance organization’s (HMO’s) implementation of a pediatric hospitalist system affected LOS, costs, mortality, readmission rate, follow-up rate, and parents’ ratings of care.

Design. Interrupted time-series study of general pediatric patients admitted to a freestanding pediatric teaching hospital from 1993 to 1998. The intervention group consisted of all patients admitted to a staff model not-for-profit HMO that began using hospitalists in October 1996. Patients in other HMOs and traditional insurance groups were studied for comparison. The main outcomes were mean LOS and inflation-adjusted costs. Other outcomes included parents’ ratings of care and mortality, readmission, and follow-up rates.

Results. Immediately after the introduction of the hospitalist system, mean LOS for staff model not-for-profit HMO fell 12% (0.3 days), and mean cost of hospitalization decreased 16% ($217) compared with prehospitalist levels. Parental ratings of care, initially somewhat low, improved substantially. Seven-day follow-up rates, mortality, and readmission rates did not change. Comparison groups experienced no concurrent improvements in LOS, cost, parental ratings, mortality, or readmission rates.

Conclusions. A pediatric hospitalist system within a staff-model HMO significantly improved LOS, cost, and parental ratings of care without affecting rates of posthospitalization follow-up. Additional studies are needed both to measure broader aspects of quality and to assess the impact of such a program on patients being cared for through other types of delivery and insurance systems.

Key Words: hospitalists • pediatrics • time-series analysis • health services research

Abbreviations: LOS, length of stay • SMHMO, staff-model health maintenance organization • HMO, health maintenance organization • FTE, full-time equivalencies • APDRG, All Patient Diagnosis-Related Groups

Received for publication Oct 22, 2001; Accepted Apr 10, 2002.




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