Published online August 1, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. 267-274 (doi:10.1542/peds.2006-2286)
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ARTICLE

Impact of a Hospitalist System on Length of Stay and Cost for Children With Common Conditions

Rajendu Srivastava, MD, FRCP(C), MPHa, Christopher P. Landrigan, MD, MPHb,c, Dennis Ross-Degnan, ScDd, Stephen B. Soumerai, ScDd, Charles J. Homer, MD, MPHb, Donald A. Goldmann, MDb and Sharon Muret-Wagstaff, PhDb

a Department of Pediatrics, Primary Children's Medical Center, University of Utah Health Sciences Center, Salt Lake City, Utah
b Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
c Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
d Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Massachusetts

OBJECTIVE. This study examined mechanisms of efficiency in a managed care hospitalist system on length of stay and total costs for common pediatric conditions.

PATIENTS AND METHODS. We conducted a retrospective cohort study (October 1993 to July 1998) of patients in a not-for-profit staff model (HMO 1) and a non–staff-model (HMO 2) managed care organization at a freestanding children's hospital. HMO 1 introduced a hospitalist system for patients in October 1996. Patients were included if they had 1 of 3 common diagnoses: asthma, dehydration, or viral illness. Linear regression models examining length-of-stay–specific costs for prehospitalist and posthospitalist systems were built. Distribution of length of stay for each diagnosis before and after the system change in both study groups was calculated. Interrupted time series analysis tested whether changes in the trends of length of stay and total costs occurred after implementation of the hospitalist system by HMO1 (HMO 2 as comparison group) for all 3 diagnoses combined.

RESULTS. A total of 1970 patients with 1 of the 3 study conditions were cared for in HMO 1, and 1001 in HMO 2. After the hospitalist system was introduced in HMO 1, length of stay was reduced by 0.23 days (13%) for asthma and 0.19 days (11%) for dehydration; there was no difference for patients with viral illness. The largest relative reduction in length of stay occurred in patients with a shorter length of stay whose hospitalizations were reduced from 2 days to 1 day. This shift resulted in an average cost-per-case reduction of $105.51 (9.3%) for patients with asthma and $86.22 (7.8%) for patients with dehydration. During the same period, length of stay and total cost rose in HMO 2.

CONCLUSIONS. Introduction of a hospitalist system in one health maintenance organization resulted in earlier discharges and reduced costs for children with asthma and dehydration compared with another one, with the largest reductions occurring in reducing some 2-day hospitalizations to 1 day. These findings suggest that hospitalists can increase efficiency and reduce costs for children with common pediatric conditions.

Key Words: hospitalists, pediatrics • health services research • cost savings • length of stay

Abbreviations: LOS—length of stay • HMO—health maintenance organization • AP-DRG—all patient diagnosis-related groups

Accepted Mar 19, 2007.