Inpatient Residency Programs are often seen as expensive care models with poor utilization. Literature reviews, comparing Academic Medical Centers (AMCs) to Community Hospitals, do not support this. Many Internal Medicine Residencies, however, are Community‐based with variable associations with AMCs. Little empirical data is available to support or refute the assertion that Community‐based Resident exposure comes with excess inpatient utilization. This lack of evidence may erode the mission of programs given declining GME subsidies. Defining the impact of Resident exposure on utilization and quality may support the mission of community programs Methods:
We designed a retrospective cohort study (01/01/04 ‐12/31/04) in which 1899 hospitalized patients with significant resident exposure (in an Academic Hospitalist Model), and 11,004 patients without, were analyzed with a Hospitalist Performance Dashboard. Demographics, Payor‐mix exposure, CMI, LOS and Mortality (both indexed to state norms), Cost/Case, Readmission Rates, Percent Daily Discharges, and Core Measures were analyzed with SPSS. All results were Severity Adjusted or Adjusted for Risk of Mortality.
Summary of Results:
1899 of 12907 patients received significant resident exposure. Demographic differences were accounted for by analysis of variance. The resident population had a significantly higher Medicaid (29.2 % vs. 11.9 %) and Self‐Pay (5.1 % vs. 1.3 %) exposure. No difference was present in overall CMI. Severity of Illness Classifications were higher in the resident cohort. Expected LOS was comparable. Average LOS was lower (4.73 vs. 6.21 days, P = .000). Unadjusted Mortality Rate (2.42 vs. 3.38 %, P = 0.015) was lower though this did not persist after adjustment. Cost/case ($7,856 vs. $9,655, P = 0.000) was lower with less deviation from institutional norms for cost/case (‐$942 vs. $445, P = 0.000). Readmission rates were comparable. Residents were more likely to comply with Core Measures. The estimated Net Annual Hospital Gain was 1.87 to 1.97 milllion dollars when indexed to state norms and 2.92 to 3.28 million dollars when indexed to institutional norms.
Statement of Conclusions:
In our Community‐Based Hospital, significant Internal Medicine Resident exposure, despite an adverse Payor‐Mix and higher SOI scores, resulted in lower LOS and Cost/Case without compromising Readmission Rates, Inpatient Mortality, or compliance with Core Measures. Health care economics studies, at the level of Community‐based Internal Medicine Residencies, are scant. This study provides such an analysis, proposes a performance dashboard other programs can adopt, and suggests resident directed care is economical, and efficient while quality outcomes are preserved. Our results have important implications in an era of declining GME reimbursement.
Author Disclosure Block:
B.G. Lee, None; H. Saad, None.