• Moaath K Mustafa Ali, Marwa M Sabha, Sarah K Mustafa, Momen Banifadel, Sami Ghazaleh, Kanana M Aburayyan, Marcel T Ghanim, Mohammed T Awad, Damynus N Gekonde, Amala R Ambati, Ahmad Ramahi, Ahmed M Elzanaty, Zeid Nesheiwat, Pinang M Shastri, Mohammad Al-Sarie, and John McGready.
• Department of Medicine, University of Toledo/Promedica Toledo Hospital, Toledo, OH, USA. moaath_mustafa@yahoo.com.
• J Gen Intern Med. 2021 Oct 1; 36 (10): 3040-3051.

BackgroundThere are no prospective studies comparing hospitalization and post-hospitalization outcomes between teaching internal medicine services and non-teaching hospitalists, and no prospective studies comparing these outcomes between locum and employed hospitalists.ObjectiveTo compare the length of stay, hospital costs readmission rate, and mortality rate in patients treated by teaching internal medicine services vs. hospitalists and among patients treated by locum vs. employed hospitalists.DesignProspective cohort study. Propensity score was used to obtain weighted estimates.SettingReferral center.PatientsAll patients 18 years and older admitted to internal medicine services.InterventionTreatment by teaching internal medicine services vs. hospitalists. Treatment by locum hospitalists vs. employed hospitalists.Main MeasuresPrimary outcome was adjusted length of stay and secondary outcomes included hospital cost, inpatient mortality, 30-day all-cause readmission, and 30-day mortality.Key ResultsA total of 1273 patients were admitted in the study period. The mean patient age was 61 ± 19 years, and the sample was 52% females. Teaching internal medicine physicians admitted 526 patients and non-teaching hospitalists admitted 747 patients. Being seen exclusively by teaching internal medicine physicians comports with a shorter adjusted hospital stay by 0.6 days (95% CI - 1.07 to - 0.22, P = .003) compared to non-teaching hospitalists. Adjusted length of stay was 1 day shorter in patients seen exclusively by locums compared to patients seen exclusively by employed services (95% CI - 1.6 to - 0.43, P < .001) with an adjusted average hospital cost saving of 1339 dollars (95% CI - 2037 to - 642, P < .001). There was no statistically significant difference in other outcomes.ConclusionsTeaching internal medicine services care was associated with a shorter stay but not with increased costs, readmission, or mortality compared to non-teaching services. In contrary to the "expected," patients treated by locums had shorter stays and decreased hospital costs but no increase in readmissions or mortality.© 2021. Society of General Internal Medicine.

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