A comparison of conventional and expanded physician assistant hospitalist staffing models at a community hospital

Objective: To determine whether a higher than conventional physician assistant (PA)-to-physician hospitalist staffing ratio can achieve similar clinical outcomes for inpatients at a community hospital. Methods: Retrospective cohort study comparing 2 hospitalist groups at a 384-bed community hospital, one with a high PA-to-physician ratio model ("expanded PA"), with 3 physicians/3 PAs and the PAs rounding on 14 patients a day (35.73% of all visits), and the other with a low PA-to-physician ratio model ("conventional"), with 9 physicians/2 PAs and the PAs rounding on 9 patients a day (5.89% of all visits). For 16,964 adult patients discharged by the hospitalist groups with a medical principal APR-DRG code between January 2012 and June 2013, in-hospital mortality, cost of care, readmissions, length of stay (LOS) and consultant use were analyzed using logistic regression and adjusted for age, insurance status, severity of illness, and risk of mortality. Results: No statistically significant differences were found between the 2 groups for in-hospital mortality (odds ratio [OR], 0.89 [95% confidence interval {CI}, 0.66-1.19]; P= 0.42), readmissions (OR, 0.95 [95% CI, 0.87-1.04]; P= 0.27), length of stay (effect size 0.99 days shorter LOS in expanded PA group, 95% CI, 0.97 to 1.01 days; P = 0.34) or consultant use (OR 1.00, 95% CI 0.94-1.07, P= 0.90). Cost of care was less in the expanded PA group (effect size 3.52% less; estimated cost $2644 vs $2724; 95% CI 2.66%-4.39%, P< 0.001). Conclusion: An expanded PA hospitalist staffing model at a community hospital provided similar outcomes at a lower cost of care.