Acute Care/Hospitalization

Multidisciplinary physician/nurse practitioner teams can reduce the costs of hospital care while maintaining care quality

A growing number of hospitals are using hospitalists, physicians who are specialized in hospital care, to manage patients while they are at the hospital. However, attending physicians in academic medical centers usually cannot spend enough time on inpatient activities to meet the definition of a hospitalist. A new study supported by the Agency for Healthcare Research and Quality (HS10734), indicates that teams comprised of multidisciplinary physicians and nurse practitioners (NPs), working together on daily rounds and postdischarge patient follow-up, can reduce the costs of inpatient care.

The Multi-Disciplinary Doctor-Nurse Practitioner (MDNP) intervention examined the costs of the MDNP alternative to costs of the pure hospitalist model. Researchers randomized 1,207 general medicine inpatients at the center to usual care or the intervention. Usual care was that care commonly used by physicians and used hospitalists to provide care and once-weekly multidisciplinary rounds. The intervention group were physicians who were given inservice education regarding the role of the hospitalist, the "physician/hospitalist." In addition, the intervention added an NP to each of the two general medicine teams of physician/hospitalist; daily multidisciplinary rounds; a hospitalist medical director; and increased staffing of attending hospitalists. Hospital-based physicians directed the intervention ward, but unlike the usual hospitalist model, hospitalists did not supplant other internists involved in the care of the patients.

NPs followed protocols to minimize overuse of unneeded services, such as limiting the use of cardiac monitoring and narrowing use of broad-spectrum antibiotics when indicated. Intervention costs were $1,187 per patient and were associated with a significant $3,331 reduction in usual care costs. About $1,947 of the savings were realized during the initial hospital stay, with the remainder attributable to reductions in postdischarge service use. A reasonable estimate of the cost offset was $2,165, minus an estimated $1,187 per-patient cost for the intervention, for a net cost savings of $978 per patient. Patient perceptions of care and health-related quality of life were at least as good for intervention as usual care patients.

See "An alternative approach to reducing the costs of patient care? A controlled trial of the multi-disciplinary doctor-nurse practitioner (MDNP) model," by Susan L. Ettner, Ph.D., Jenny Kotlerman, M.S., Abdelmonem Afifi, Ph.D., and others in the January 2006 Medical Decision Making 26, pp. 9-17.

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