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Cost and effectiveness comparison between wards under hospitalists’ and residents’ services
hospitalist,work hour of residents,nocturnist,
|Publication Year :||2016|
This study aims to identify a service system in general medical ward in order to deal with the work hour reduction of resident and emergency department overcrowding of the National Taiwan University Hospital (NTUH). Currently, there are two different service systems in the general wards of NTUH for patients admitted from the emergency department. One is the holistic care model in 7AD wards led by hospitalists of the Department of Traumatology, the other is the traditional care model in7B ward led by internists and residents of the Department of Internal Medicine. The hospitalist service model has been shown superior to internist model in reducing length of stay and medical expense. However, after taking the issue of high personnel cost into account, a cost and benefit analysis is mandatory to identify the superiority of two service model. Whether there will be a third model, such as a mixed model of combing both hospitalist/nursing specialist and traditional internist/resident, can be established to achieve a similar level in quality of care and patient outcome as hospitalist is the key purpose of this study。
We retrospectively collected the medical information of all patients admitted to 7AD and 7B wards from Jan 1st to Dec 31st 2014, comparing the quality indices (length of stay, in-hospital death, readmission within 30 days), medical expense (including that paid by NHI and from patients’ own pocket), all costs (direct and indirect) of the service and the profits (by calculation) between these two service models. There were 1859 patients being admitted to 7A/D and 602patients to 7B ward in the study period. The results confirm that the hospitalist/nursing specialist service model is indeed superior to internist/resident service model in length of stay, bed turnover, number of patients admitted from emergency department and lower medical expense. However, due to a much higher personnel cost, the hospitalist model has no economic benefits. Comparing to the internist model, all of the 5 mixed models significantly increase the number of patients admitted and the income from health care, and also provide better economic benefits than hospitalist model. Putting the compliance to resident work hour limitation into consideration, a mixed model with 2 teams of hospitalists/nursing specialist and 2 teams of internists/residents, and 0.5 nocturnist (1 nocturnist for 2 wars), will be the best resolution to help NTUH solving both the overcrowding of emergency department and the work hour reduction of residents.
|Appears in Collections:||商學組|
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