RT Journal
A1 Auerbach AD, Wachter RM, Cheng H, et al
T1 COmanagement of surgical patients between neurosurgeons and hospitalists
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2010
FD December 13
VO 170
IS 22
SP 2004
OP 2010
DO 10.1001/archinternmed.2010.432
UL http://dx.doi.org/10.1001/archinternmed.2010.432
AB Background 
    Shared management of surgical patients between surgeons and hospitalists (comanagement) is increasingly common, yet few studies have described its effects.Methods 
    Retrospective, interrupted time-series analysis of data collected from adults admitted to a neurosurgery service at our university-based teaching hospital between June 1, 2005, and December 31, 2008. Data regarding length of stay, costs, inpatient mortality rate, and 30-day readmission rate were collected from administrative sources; patient and caregiver satisfaction was assessed through surveys. We used multivariable models to estimate the effect of comanagement on key outcomes after adjusting for secular trends and patient-specific risk factors.Results 
    During the study period, 7596 patients were admitted to the neurosurgery service: 4203 (55.3%) before July 1, 2007, and 3393 (44.7%) after comanagement began. Of those admitted during the postimplementation period, 988 (29.1%) were comanaged. After implementation of comanagement, no differences were found in patient mortality rate, readmission, or length of stay. No consistent improvements were seen in patient satisfaction, but strong perceived improvements occurred in care quality reported by nurses and nonnurse health care professionals. In addition, we observed a reduction in hospital costs of $1439 per admission.Conclusions 
    Implementation of a hospitalist comanagement service had little effect on patient outcomes or satisfaction but appeared to reduce hospital costs and improve health care professionals' perceptions of care quality. As comanagement models are adopted, more emphasis should be placed on developing systems that improve patient outcomes.