The Effect of Geographic Cohorting of Inpatient Teaching Services on Patient Outcomes and Resident Experience.
Publication/Presentation Date
1-24-2022
Abstract
BACKGROUND: Geographic cohorting is a hospital admission structure in which every patient on a given physician team is admitted to a dedicated hospital unit. Little is known about the long-term impact of this admission structure on patient outcomes and resident satisfaction.
OBJECTIVE: To evaluate the effect of geographic cohorting on patient outcomes and resident satisfaction among inpatient internal medicine teaching services within an academic hospital.
DESIGN AND INTERVENTION: We conducted an interrupted time series analysis examining patient outcomes before and after the transition to geographic cohorting of our 3 inpatient teaching services within a 520-bed academic hospital in November 2017. The study observation period spanned from January 2017 to October 2018, allowing for a 2-month run-in period (November-December 2017).
PARTICIPANTS: We included patients discharged from the inpatient teaching teams during the study period. We excluded patients admitted to the ICU and observation admissions.
MAIN MEASURES: Primary outcome was 6-month mortality adjusted for patient age, sex, race, insurance status, and Charlson Comorbidity Index (CCI) analyzed using a linear mixed effects model. Secondary outcomes included hospital length of stay (LOS), 7-day and 30-day readmission rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and resident evaluations of the rotation.
KEY RESULTS: During the observation period, 1720 patients (mean age 64, 53% female, 56% white, 62% Medicare-insured, mean CCI 1.57) were eligible for inclusion in the final adjusted model. We did not detect a significant change in 6-month mortality, LOS, and 7-day or 30-day readmission rates. HCAHPS scores remained unchanged (77 to 80% top box, P = 0.19), while resident evaluations of the rotation significantly improved (mean overall score 3.7 to 4.0, P = 0.03).
CONCLUSIONS: Geographic cohorting was associated with increased resident satisfaction while achieving comparable patient outcomes to those of traditional hospital admitting models.
ISSN
1525-1497
Published In/Presented At
Klein, A. J., Veet, C., Lu, A., Kennedy, A. J., Agonafer, E., Grau, T., Rothenberger, S. D., & Corbelli, J. (2022). The Effect of Geographic Cohorting of Inpatient Teaching Services on Patient Outcomes and Resident Experience. Journal of general internal medicine, 10.1007/s11606-021-07387-z. Advance online publication. https://doi.org/10.1007/s11606-021-07387-z
Disciplines
Medicine and Health Sciences
PubMedID
35075536
Department(s)
Department of Medicine
Document Type
Article