• Stacy A Johnson, Claire E Ciarkowski, Katie L Lappe, David R Kendrick, Adrienne Smith, and Santosh P Reddy.
• Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.
• J Hosp Med. 2020 Dec 1; 15 (12): 709-715.

BackgroundAcademic medical centers have expanded their inpatient medicine services with advanced practice clinicians (APCs) or nonteaching hospitalists in response to patient volumes, residency work hour restrictions, and recently, COVID-19. Reports of clinical outcomes, cost, and resource utilization differ among inpatient team structures.ObjectiveDirectly compare outcomes among resident, APC, and solo hospitalist inpatient general medicine teams.DesignRetrospective cohort study using multivariable analysis adjusted for time of admission, interhospital transfer, and comorbidities that compares clinical outcomes, cost, and resource utilization.SubjectsPatients 18 years or older discharged from an inpatient medicine service between July 2015 and July 2018 (N = 12,716).Main MeasuresLength of stay (LOS), 30-day readmission, inpatient mortality, normalized total direct cost, discharge time, and consultation utilization.Key ResultsResident teams admitted fewer patients at night (32.0%; P < .001) than did APC (49.5%) and hospitalist (48.6%) teams. APCs received nearly 4% more outside transfer patients (P = .015). Hospitalists discharged patients 26 minutes earlier than did residents (mean hours after midnight [95% CI], 14.58 [14.44-14.72] vs 15.02 [14.97-15.08]). Adjusted consult utilization was 15% higher for APCs (adjusted mean consults per admission [95% CI], 1.00 [0.96-1.03]) and 8% higher for residents (0.93 [0.90-0.95]) than it was for hospitalists (0.85 [0.80-0.90]). No differences in LOS, readmission, mortality, or cost were observed between the teams.ConclusionWe observed similar costs, LOS, 30-day readmission, and mortality among hospitalist, APC, and resident teams. Our results suggest clinical outcomes are not significantly affected by team structure. The addition of APC or hospitalist teams represent safe and effective alternatives to traditional inpatient resident teams.

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