| Titre : | Reorganizing an academic medical service impact on cost, quality, patient satisfaction, and education. (1998) |
| Auteurs : | R.M. WACHTER ; A.B. BINDMAN ; L. GOLDMAN ; P. KATZ ; J. SHOWSTACK ; Department of Medicine. University of California. San Francisco. USA ; Institute for Heath Policy Studies. University of California. San Francisco. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 279, n° 19, 1998) |
| Pagination : | 1560-1565 |
| Langues: | Anglais |
| Mots-clés : | Centre santé ; Analyse coût efficacité ; Education ; Homme ; Etats Unis ; Amérique du Nord ; Amérique |
| Résumé : | [BDSP. Notice produite par INIST CR0x5olS. Diffusion soumise à autorisation]. Context. - Academic medical centers are under enormous pressure to improve quality and cut costs while preserving education. Objectlve. To determine whether a reorganized academic medical service, led by faculty members who attended more often and became involved earlier and more intensively in care, would lower costs without compromising quality and education. Design. - Alternate-day controlled trial. Setting. - Inpatient academic general medical service. Patients. - The 1623 patients discharged from the Moffitt-Long medical service between July 1,1995, and June 30,1996. Interventions. - We divided our 4-team inpatient general medical service into 2 managed care service (MCS) teams and 2 traditional service (TS) teams. The MCS faculty served as attending physicians more often and were required to provide early input into clinical decisions. Patients were assigned to teams based on alternate days of admission. Main Outcome Measures. - Outcome measures included resource use and outcomes for MCS vs TS patients, and for MCS patients vs patients seen the previous year, adjusted for demographic characteristics and case mix. Satisfaction of patients, house staff, and faculty was also assessed, as was educational emphasis. Results. - A total of 806 patients were admitted to the MCS - and 817 to the TS. Demographic characteristics and case mix were-similar. Clinical outcomes, including mortality and readmission rates, were also similar, as was patient satisfaction. (...) |
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