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Are Geriatricians More Efficient Than Other Physicians at Managing Inpatient Care for Elderly Patients?
Author(s) -
Sorbero Melony E.,
Saul Melissa I.,
Liu Hangsheng,
Resnick Neil M.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.03934.x
Subject(s) - medicine , multivariate analysis , specialty , propensity score matching , inpatient care , medical diagnosis , emergency medicine , geriatrics , family medicine , health care , pathology , psychiatry , economics , economic growth
Objectives To compare outcomes and measures of efficiency for hospitalized elderly adults managed by geriatricians with those managed by other physicians. Design Secondary data analysis using a system that integrates clinical and financial information for inpatient and outpatient services delivered throughout the U niversity of P ittsburgh M edical C enter ( UPMC ). Propensity scores were developed based on participant sociodemographic and clinical characteristics and used to match participants based on the attending physician's specialty (geriatrician, n = 701; nongeriatrician, n = 11,549). Multivariate analyses using generalized estimating equations methods were performed. Setting Two UPMC hospitals in P ittsburgh, P ennsylvania. Participants Patients aged 65 and older admitted in 2002 in a medical diagnosis‐related group ( DRG ). Measurements Outcomes (inpatient mortality, 30‐day mortality, readmission) and efficiency measures (length of stay, total costs, and surplus, which is the difference between hospital costs and payment received for an admission). Results Elderly adults managed by geriatricians were significantly older ( P < .001) and more likely to be male ( P < .001) and had more diagnoses ( P < .001). Propensity scores successfully balanced characteristics managed by the two groups. Patients of geriatricians had shorter length of stay ( P < .001), lower costs per admission ( P < .001), and greater surplus ( P < .001) with no differences in outcomes. In multivariate analyses, there were not significant differences in outcomes, but patients of geriatricians had significantly shorter length of stay and lower costs per admission and generated more surplus for the hospitals. Conclusion Geriatricians were more efficient than other physicians in managing hospitalized elderly adults with medical DRG s frequently managed by geriatricians. This efficiency did not compromise patient outcomes.