Background: Opening new residency programs in community hospitals is one strategy to address physician shortage. Previous reports showed better 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 naïve for- profit community hospital.
Methods: In a retrospective cross-sectional study, we compared quality and efficiency parameters for the same hospitalist service for the year before (July 2015- June 2016) and after (July 2016- June 2017) starting the Internal Medicine residency program first class at the Riverside Community Hospital(RCH).The quality measures including mortality rate, 30-day readmission rate, complications of care (unexpected outcomes following the care provided), average cost per case, and length of stay were extracted from Crimson, which is the data reporting tool for RCH. Microsoft Excel and Openepi statistical tools were used for data analysis.
Results: 2589 patients were admitted before and 2581 patients were admitted after starting the residency program.Mortality rate decreased significantly (1.16% vs 2.24% p=0.003). There was no significant difference between the 2 groups for the 30-day readmission rate (9.8% vs 10.0% p=0.8) and complications of care (1.5% vs 1.47% p=0.86).
The average cost per patient decreased 339$ (p=0.23) and the average length of stay decreased 0.2 days (from 5.9 to 5.7 days) (p=0.26).
Conclusions: Our results support that starting a new residency program in a for-profit community hospital is not associated with a decline in the quality of patient care, and significantly decreases the overall mortality rate in this patient population. Although the decrease in the average cost of care and length of stay was not statistically significant, their decline is encouraging.
This should reassure for-profit hospitals that opening training programs could have a positive impact on their patient’s care and overall workflow. Since these results reflect the impact of an intern-only service, additional studies with a fully enrolled residency program are planned.