A Comparison of Conventional and Expanded Physician Assistant Hospitalist Staffing Models at a Community Hospital

Readmissions

Overall, 929 of 6612 (14.05%) and 1417 of 10,352 (13.69%) patients were readmitted after being discharged by the expanded PA and conventional groups, respectively. After multivariate analysis, there was no statistically significant difference in odds of readmission between the groups (OR for conventional group, 0.95 [95% CI, 0.87–1.04]; P = 0.27). 

Inpatient Mortality

Unadjusted inpatient mortality for the expanded PA group was 1.30% and 0.99% for the conventional group.  After multivariate analysis, there was no statistically significant difference in odds of in-hospital mortality between the groups (OR for conventional group, 0.89 [95% CI, 0.66–1.19]; P = 0.42).

Patient Charges

The unadjusted mean patient charge in the expanded PA group was $7822 ± $7755 and in the conventional group mean patient charge was $8307 ± 10,034. Multivariate analysis found significantly lower adjusted patient charges in the expanded PA group relative to the conventional group (3.52% lower in the expanded PA group [95% CI, 2.66%–4.39%, P < 0.001). When comparing a “standard” patient who was between 80–89 and had Medicare insurance and an SOI of “major,” the cost of care was $2644 in the expanded PA group vs $2724 in the conventional group.

Length of Stay

Unadjusted mean length of stay was 4.1 ± 3.9 days and 4.3 ± 5.6 days for the expanded PA and conventional groups, respectively. After multivariate analysis, when comparing the statistical model “standard” patient, there was no significant difference in the length of stay between the 2 groups (effect size, 0.99 days shorter LOS in the expanded PA group [95% CI, 0.97–1.01 days]; P = 0.34)

Consultant Use

Utilization of consultants was also assessed. The expanded PA group used a mean of 0.55 consultants per case, and the conventional group used 0.56. After multivariate adjustment, there was no significant difference in consulting service use between groups (OR 1.00 [95% CI, 0.94–1.07]; P = 0.90).