A comparison of conventional and expanded physician assistant hospitalist staffing models at a community hospital

Timothy M. Capstack, Cissy Segujja, Lindsey M. Vollono, Joseph D. Moser, Barry R. Meisenberg, Henry Joseph Michtalik

Research output: Contribution to journalArticle

Abstract

Objective: To determine whether a higher than conventional physician assistant (PA)-to-physician hospitalist staffing ratio can achieve similar clinical outcomes for inpatients at a community hospital. Methods: Retrospective cohort study comparing 2 hospitalist groups at a 384-bed community hospital, one with a high PA-to-physician ratio model ("expanded PA"), with 3 physicians/3 PAs and the PAs rounding on 14 patients a day (35.73% of all visits), and the other with a low PA-to-physician ratio model ("conventional"), with 9 physicians/2 PAs and the PAs rounding on 9 patients a day (5.89% of all visits). For 16,964 adult patients discharged by the hospitalist groups with a medical principal APR-DRG code between January 2012 and June 2013, in-hospital mortality, cost of care, readmissions, length of stay (LOS) and consultant use were analyzed using logistic regression and adjusted for age, insurance status, severity of illness, and risk of mortality. Results: No statistically significant differences were found between the 2 groups for in-hospital mortality (odds ratio [OR], 0.89 [95% confidence interval {CI}, 0.66-1.19]; P= 0.42), readmissions (OR, 0.95 [95% CI, 0.87-1.04]; P= 0.27), length of stay (effect size 0.99 days shorter LOS in expanded PA group, 95% CI, 0.97 to 1.01 days; P = 0.34) or consultant use (OR 1.00, 95% CI 0.94-1.07, P= 0.90). Cost of care was less in the expanded PA group (effect size 3.52% less; estimated cost $2644 vs $2724; 95% CI 2.66%-4.39%, P< 0.001). Conclusion: An expanded PA hospitalist staffing model at a community hospital provided similar outcomes at a lower cost of care.

Original languageEnglish (US)
Pages (from-to)455-461
Number of pages7
JournalJournal of Clinical Outcomes Management
Volume23
Issue number10
StatePublished - Oct 1 2016

Fingerprint

Hospitalists
Physician Assistants
Community Hospital
Confidence Intervals
Physicians
Length of Stay
Odds Ratio
Consultants
Hospital Mortality
Costs and Cost Analysis
Insurance Coverage
Hospital Costs
Diagnosis-Related Groups
Inpatients
Cohort Studies
Retrospective Studies
Logistic Models
Mortality

ASJC Scopus subject areas

  • Medicine(all)
  • Health Policy

Cite this

A comparison of conventional and expanded physician assistant hospitalist staffing models at a community hospital. / Capstack, Timothy M.; Segujja, Cissy; Vollono, Lindsey M.; Moser, Joseph D.; Meisenberg, Barry R.; Michtalik, Henry Joseph.

In: Journal of Clinical Outcomes Management, Vol. 23, No. 10, 01.10.2016, p. 455-461.

Research output: Contribution to journalArticle

Capstack, Timothy M. ; Segujja, Cissy ; Vollono, Lindsey M. ; Moser, Joseph D. ; Meisenberg, Barry R. ; Michtalik, Henry Joseph. / A comparison of conventional and expanded physician assistant hospitalist staffing models at a community hospital. In: Journal of Clinical Outcomes Management. 2016 ; Vol. 23, No. 10. pp. 455-461.
@article{4765b5d632c346ada83a2281b3f42509,
title = "A comparison of conventional and expanded physician assistant hospitalist staffing models at a community hospital",
abstract = "Objective: To determine whether a higher than conventional physician assistant (PA)-to-physician hospitalist staffing ratio can achieve similar clinical outcomes for inpatients at a community hospital. Methods: Retrospective cohort study comparing 2 hospitalist groups at a 384-bed community hospital, one with a high PA-to-physician ratio model ({"}expanded PA{"}), with 3 physicians/3 PAs and the PAs rounding on 14 patients a day (35.73{\%} of all visits), and the other with a low PA-to-physician ratio model ({"}conventional{"}), with 9 physicians/2 PAs and the PAs rounding on 9 patients a day (5.89{\%} of all visits). For 16,964 adult patients discharged by the hospitalist groups with a medical principal APR-DRG code between January 2012 and June 2013, in-hospital mortality, cost of care, readmissions, length of stay (LOS) and consultant use were analyzed using logistic regression and adjusted for age, insurance status, severity of illness, and risk of mortality. Results: No statistically significant differences were found between the 2 groups for in-hospital mortality (odds ratio [OR], 0.89 [95{\%} confidence interval {CI}, 0.66-1.19]; P= 0.42), readmissions (OR, 0.95 [95{\%} CI, 0.87-1.04]; P= 0.27), length of stay (effect size 0.99 days shorter LOS in expanded PA group, 95{\%} CI, 0.97 to 1.01 days; P = 0.34) or consultant use (OR 1.00, 95{\%} CI 0.94-1.07, P= 0.90). Cost of care was less in the expanded PA group (effect size 3.52{\%} less; estimated cost $2644 vs $2724; 95{\%} CI 2.66{\%}-4.39{\%}, P< 0.001). Conclusion: An expanded PA hospitalist staffing model at a community hospital provided similar outcomes at a lower cost of care.",
author = "Capstack, {Timothy M.} and Cissy Segujja and Vollono, {Lindsey M.} and Moser, {Joseph D.} and Meisenberg, {Barry R.} and Michtalik, {Henry Joseph}",
year = "2016",
month = "10",
day = "1",
language = "English (US)",
volume = "23",
pages = "455--461",
journal = "Journal of Clinical Outcomes Management",
issn = "1079-6533",
publisher = "Turner White Communications Inc.",
number = "10",

}

TY - JOUR

T1 - A comparison of conventional and expanded physician assistant hospitalist staffing models at a community hospital

AU - Capstack, Timothy M.

AU - Segujja, Cissy

AU - Vollono, Lindsey M.

AU - Moser, Joseph D.

AU - Meisenberg, Barry R.

AU - Michtalik, Henry Joseph

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Objective: To determine whether a higher than conventional physician assistant (PA)-to-physician hospitalist staffing ratio can achieve similar clinical outcomes for inpatients at a community hospital. Methods: Retrospective cohort study comparing 2 hospitalist groups at a 384-bed community hospital, one with a high PA-to-physician ratio model ("expanded PA"), with 3 physicians/3 PAs and the PAs rounding on 14 patients a day (35.73% of all visits), and the other with a low PA-to-physician ratio model ("conventional"), with 9 physicians/2 PAs and the PAs rounding on 9 patients a day (5.89% of all visits). For 16,964 adult patients discharged by the hospitalist groups with a medical principal APR-DRG code between January 2012 and June 2013, in-hospital mortality, cost of care, readmissions, length of stay (LOS) and consultant use were analyzed using logistic regression and adjusted for age, insurance status, severity of illness, and risk of mortality. Results: No statistically significant differences were found between the 2 groups for in-hospital mortality (odds ratio [OR], 0.89 [95% confidence interval {CI}, 0.66-1.19]; P= 0.42), readmissions (OR, 0.95 [95% CI, 0.87-1.04]; P= 0.27), length of stay (effect size 0.99 days shorter LOS in expanded PA group, 95% CI, 0.97 to 1.01 days; P = 0.34) or consultant use (OR 1.00, 95% CI 0.94-1.07, P= 0.90). Cost of care was less in the expanded PA group (effect size 3.52% less; estimated cost $2644 vs $2724; 95% CI 2.66%-4.39%, P< 0.001). Conclusion: An expanded PA hospitalist staffing model at a community hospital provided similar outcomes at a lower cost of care.

AB - Objective: To determine whether a higher than conventional physician assistant (PA)-to-physician hospitalist staffing ratio can achieve similar clinical outcomes for inpatients at a community hospital. Methods: Retrospective cohort study comparing 2 hospitalist groups at a 384-bed community hospital, one with a high PA-to-physician ratio model ("expanded PA"), with 3 physicians/3 PAs and the PAs rounding on 14 patients a day (35.73% of all visits), and the other with a low PA-to-physician ratio model ("conventional"), with 9 physicians/2 PAs and the PAs rounding on 9 patients a day (5.89% of all visits). For 16,964 adult patients discharged by the hospitalist groups with a medical principal APR-DRG code between January 2012 and June 2013, in-hospital mortality, cost of care, readmissions, length of stay (LOS) and consultant use were analyzed using logistic regression and adjusted for age, insurance status, severity of illness, and risk of mortality. Results: No statistically significant differences were found between the 2 groups for in-hospital mortality (odds ratio [OR], 0.89 [95% confidence interval {CI}, 0.66-1.19]; P= 0.42), readmissions (OR, 0.95 [95% CI, 0.87-1.04]; P= 0.27), length of stay (effect size 0.99 days shorter LOS in expanded PA group, 95% CI, 0.97 to 1.01 days; P = 0.34) or consultant use (OR 1.00, 95% CI 0.94-1.07, P= 0.90). Cost of care was less in the expanded PA group (effect size 3.52% less; estimated cost $2644 vs $2724; 95% CI 2.66%-4.39%, P< 0.001). Conclusion: An expanded PA hospitalist staffing model at a community hospital provided similar outcomes at a lower cost of care.

UR - http://www.scopus.com/inward/record.url?scp=84991510911&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84991510911&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:84991510911

VL - 23

SP - 455

EP - 461

JO - Journal of Clinical Outcomes Management

JF - Journal of Clinical Outcomes Management

SN - 1079-6533

IS - 10

ER -