The creating incentives and continuity leading to efficiency staffing model: A quality improvement initiative in hospital medicine

Objective: To determine the effect of a hospitalist-developed, continuity-centered hospitalist staffing model on patient outcomes and resource use. Methods: The Creating Incentives and Continuity Leading to Efficiency (CICLE) staffing model was conceived by a group of hospitalists who sought to improve continuity of inpatient care. Using a retrospective, observational, pre-post study design, we compared patient-level data for all discharges from our hospitalist service from 6 months after implementation of the CICLE staffing model (September 1, 2009, through February 28, 2010; n=1585) with data from those same months in the prior year (September 1, 2008, through February 28, 2009; n=1808). We used the number of unique hospitalists who documented an encounter during the admission as a measure of continuity of care. Length of stay and hospital charges per admission constituted the measures of resource use. Results: The odds of having a single hospitalist for the entire hospitalization nearly doubled under the CICLE model (odds ratio, 1.87; 95% confidence interval, 1.60-2.2; P<.001). Mean length of stay decreased 7.5% (from 2.92 before to 2.70 days after initiation of the model; P<.001). Mean hospital charge per admission decreased 8.5% (from $7224.33 before to $6607.79 after initiation of the model; P<.001). Thirty-day readmission rates were not substantially affected by the CICLE model (15.0% before to 17.3% after initiation of the model; P<.08). Conclusion: Improved continuity of care among hospitalists was associated with reductions in length of stay and lower health care costs. These benefits were realized without substantially affecting readmission rates. The staffing model can be achieved by reorganizing existing hospitalists and may not require the hiring of additional personnel. The CICLE staffing model is a viable option for hospitalist groups that are aiming to diminish resource use and improve quality of care.