Are Geriatricians More Efficient Than Other Physicians at Managing Inpatient Care for Elderly Patients?
Published in: Journal of the American Geriatrics Society, v. 60, no. 5, May 2012, p. 869-876
Posted on RAND.org on May 01, 2012
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 University of Pittsburgh Medical Center (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 Pittsburgh, Pennsylvania. 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 DRGs frequently managed by geriatricians. This efficiency did not compromise patient outcomes.