Background: Opening new residency programs in community hospitals is one strategy to address physician shortage. Previous reports have shown better mortality outcomes in university based hospitals. However, less is known about teaching community hospitals. Disrupting well- established workflows in community hospitals is feared to cause an increased cost and possibly a slide in quality of care. Our aim was to assess the impact of starting a new Internal Medicine residency program in a Graduate Medical Education (GME) naïve community hospital.
Methods: In a retrospective longitudinal study, we compared quality and efficiency of care parameters for the same hospitalist service for the academic year before (July 2015- June 2016) and two years after (July 2016- June 2018 ) starting the Internal Medicine residency program at Riverside Community Hospital(RCH).The quality measures including mortality rate, 30-day readmission rate, complications of care, average cost per case, length of stay, and case mixed index were evaluated.
Results: The aggregated data from 1295, 2532, and 3061 patients in academic year 2015, 2016, and 2017 respectively was included in the study.Compared to pre-GME mortality rate of 2.4% (academic year 2015), mortality rate decreased to 1.26% for the first year and further decreased to 0.63% for the second year after the start of the residency program while the mortality rate among non-teaching hospitalist group patients remained comparable throughout three years. Other measures did not show remarkable change.
Conclusions: Starting a new residency program at a community hospital is not associated with a decline in the quality of patient care. In fact, it significantly decreases the overall mortality rate among the teaching service patient population. We hypothesize that further decrease in the mortality rate during the second year after starting the residency program is due to having senior residents to help faculties supervise interns.