Tuesday, December 21, 2010

Does Hospitalist Co-management of Surgical Patients Improve Care?

A report from the University of California, San Francisco in the December 13/27, 2010 issue of Archives of Internal Medicine shows that co-management of neurosurgery patients by medical hospitalists and neurosurgeons had no effect on patient outcomes or satisfaction but did lower costs by over $1400 per patient. Co-management led to a perception among other hospital staff that the quality of care was improved especially regarding patients with medical co-morbidities.

The before-and-after-study included 7596 neurosurgery patients, 45% of whom were admitted after the Co-management on Neurosurgery Service [CNS] was established in July of 2007 because of reductions in neurosurgery resident work hours. Prior to that date, the patients were managed by a single neurosurgery resident who was responsible for as many as 50 inpatients.

The lead author, medical hospitalist Dr. Andrew Auerbach, was asked whether the paper might also be interpreted as finding that before co-management, the lone neurosurgery resident did a good job. He agreed that “…the NS resident [care] was not all that different (in terms of our outcomes) from the CNS service model.”

He was most pleased with the responses of the staff to the changed service stating, “…the perceptions of safety and quality improvement among everyone (including the NS residents) are profound.”

The cost savings estimate did not include data on professional fees generated by the increased level of medical hospitalist participation in the service nor was the outlay for the reimbursement of the hospitalists factored in. Dr Auerbach said, “The CNS service did not produce substantial revenue; however, it required substantial subsidies from the Medical Center. As much as 70% of the total costs to operate the service came from the subsidy.”

Although the authors concluded that the service worked well especially in the area of patient safety and quality, there was no objective evidence that co-management was of value. They suggested that future co-management efforts should focus on improving outcomes.

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