Impact of Hospitalists on Length of Stay in the Medicare Population: Variation by Hospital and Patient Characteristics

Objectives—To assess how reductions in length of stay associated with hospitalist care vary by patient and hospital characteristics and explore whether these reductions in length of stay changed over time in the Medicare population. Design—Retrospective cohort study using data from a 5 % national sample of Medicare beneficiaries. Setting—Hospital. Participants—To examine temporal trends, 1,981,654 Medicare admissions in 2001 to 2006 at 5036 U.S. hospitals were used. To examine the influence of patient and hospital characteristics, 314,590 admissions in 2006 were used. Measurements—Hospital length of stay. Results—In multivariable analyses controlling for patient and hospital characteristics, the reductions in length of stay associated with hospitalist care increased from 0.02 days in 2001-02 to 0.22 days in 2003-04, and 0.35 days in 2005-06. For 2006 admissions, reductions in length of stay were greater in older patients and patients with a higher DRG weight. The reductions were three times greater for medical than for surgical DRGs, with greater reductions in length of stay at non-profit vs. for profit hospitals, and at community vs. teaching hospitals. Conclusion—The reductions in length of stay associated with hospitalist care would appear to be greatest in older, complicated, non-surgical patients cared for at community hospitals