APPENDIX
Table A1a: Patient encounter clinical subcategories, by hospital service.
*Principal diagnosis
(CCS software)
Septicemia
Pneumonia
Congestive heart failure;
nonhypertensive
Diabetes mellitus with
complications
Skin and subcutaneous tissue
infection
Complications of surgical
procedures or medical care
Urinary tract infections
Chronic obstructive pulmonary
disease and bronchiectasis
Gastrointestinal hemorrhage
Acute and unspecified renal
failure
Other diagnoses groups
Academic-preceptor
(n=5770)
n
Percent
502
8.7
330
5.7
Hospitalist-preceptor
(n=7300)
n
Percent
835
11.4
391
5.4
Hospitalist-alone
(n=7955)
n
Percent
916
11.5
451
5.7
303
5.3
408
5.6
334
4.2
234
4.1
265
3.6
297
3.7
211
3.7
217
3.0
284
3.6
148
2.6
272
3.7
246
3.1
199
3.5
214
2.9
224
2.8
161
2.8
222
3.0
246
3.1
161
2.8
204
2.8
232
2.9
145
2.5
227
3.1
156
2.0
3376
58.5
4045
55.4
4569
57.4
* Clinical Classification Software (single-level diagnosis) developed by AHRQ, was used to create encounter subcategories.
Table A1b: Comorbid conditions for all patient encounter, by hospital service.
*Comorbidities
Hypertension
Fluid and electrolyte disorder
Deficiency Anemias
Diabetes w/o Chronic Complications
Chronic Pulmonary Disease
Congestive Heart Failure
Renal Failure
Depression
Alcohol Abuse
Liver Disease
Drug Abuse
Coagulation Deficiency
Other Neurological Disorders
Diabetes with Chronic Complications
Hypothyroidism
Psychoses
Obesity
Weight loss
Rheumatoid Arthritis/Collagen Vascular
Diseases
Valvular Disease
Pulmonary Circulation Disorders
Paralysis
Peripheral Vascular Disease
Academic-preceptor
(n=5770)
Percent
n
3354
58.1
2349
40.7
2164
37.5
1543
26.7
1473
25.5
1466
25.4
1244
21.6
1056
18.3
978
17.0
894
15.5
836
14.5
680
11.8
650
11.3
637
11.0
611
10.6
595
10.3
455
7.9
394
6.8
Hospitalist-preceptor
(n=7300)
n
Percent
4621
63.3
2959
40.5
2863
39.2
2067
28.3
1996
27.3
2133
29.2
1905
26.1
1461
20.0
842
11.5
1045
14.3
785
10.8
735
10.1
925
12.7
973
13.3
974
13.3
721
9.9
573
7.9
556
7.6
Hospitalist
(n=7955)
n
Percent
4540
57.1
3060
38.5
2794
35.1
2079
26.1
2273
28.6
1974
24.8
1720
21.6
1429
18.0
977
12.3
940
11.8
884
11.1
685
8.6
920
11.6
894
11.2
869
10.9
833
10.5
677
8.5
723
9.1
387
6.7
603
8.3
474
6.0
364
358
302
294
6.3
6.2
5.2
5.1
516
482
467
413
7.1
6.6
6.4
5.7
441
448
434
414
5.5
5.6
5.5
5.2
Academic-preceptor
(n=5770)
Percent
n
Metastatic Cancer
242
4.2
Solid Tumor without Metastasis
205
3.6
Blood loss anemia
129
2.2
HIV and AIDS
100
1.7
Lymphoma
61
1.1
Chronic Peptic Ulcer Disease
5
0.1
*Comorbid conditions were determined using the Elixhauser Method.
*Comorbidities
Hospitalist-preceptor
(n=7300)
n
Percent
294
4.0
311
4.3
166
2.3
150
2.1
72
1.0
7
0.1
n
239
318
148
76
50
6
Hospitalist
(n=7955)
Percent
3.0
4.0
1.9
1.0
0.6
0.1
Table A1c: Readmission events within 14, 30 and 60 days, by hospital service.
Readmission
14-day
30-day
60-day
Academic-preceptor
(n=5770)
n
Percent
504
8.7
867
15.0
1313
22.8
Hospitalist-preceptor
(n=7300)
n
Percent
670
9.2
1094
15.0
1746
23.9
Hospitalist
(n=7955)
n
Percent
604
7.6
1013
12.7
1640
20.6
Table A2: Unadjusted patient outcomes reported on the absolute scale- 30-day readmission rate, LOS, index hospitalization cost,
cumulative cost (index encounter plus readmissions within 30 days of discharge).
Outcome
Academic-preceptor
Hospitalist-preceptor
Hospitalist-alone
30-day Readmission
Rate
15.6
15.7
11.7
95% CI
(14.3, 17.0)
(14.5, 17.0)
(10.8, 12.7)
Length of Stay *
Days
5.52
5.52
6.15
95% CI
(5.42, 5.61)
(5.43, 5.61)
(6.05, 6.25)
Cost of Index Encounter*
US $
15211
15245
16728
95% CI
(14961, 15466)
(14909, 15588)
(16338, 17128)
Cumulative Hospital Cost within
30 days*
US $
18883
17932
20777
95% CI
(18445, 19333)
(16633, 19331)
(19277, 22394)
Estimates from generalized estimating equation are reported on the original scale and adjusted for clustering, unadjusted for covariates.
* The variable was log-transformed; ratios reported are the antilog of the parameter estimate, which can be interpreted in the original scale. We
included a smearing estimator in log-linear models to account for retransformation bias.
Table A3: Unadjusted patient outcomes 30-day readmission, length of stay, difference in cost of index hospitalization, and difference
in cumulative cost (index encounter plus readmissions within 30 days of discharge).
Outcome
Academic-preceptor
vs. Hospitalist-alone
Hospitalist-preceptor
vs. Hospitalist-alone
Academic-preceptor
vs. Hospitalist-preceptor
30-day Readmission
Odds Ratio
1.20
1.18
1.01
95% CI
(1.08, 1.32)
(1.08, 1.30)
(0.92, 1.11)
p value
<0.001
<0.001
0.83
Length of Stay*
Difference in Days
-0.40
-0.38
-0.02
95% CI
(-0.50, -0.30)
(-0.48, -0.28)
(-0.13, 0.09)
p value
<0.001
<0.001
0.7280
Index Hospitalization Cost*
Cost Difference (US $)
-966
-903
-66
95% CI
(-1298, -625)
(-1309, -486)
(-382, 991)
p value
<0.001
<0.001
0.6838
Cumulative Hospital Cost within
30 days*
Cost Difference (US $)
-976
-1490
559
95% CI
(-1741, -176)
(-2765, -115)
(-320, 1477)
p value
0.0172
0.0342
0.2169
Estimates from generalized estimating equation are reported on the original scale and adjusted for clustering, unadjusted for covariates.
* The variable was log-transformed; ratios reported are the antilog of the parameter estimate, which can be interpreted in the original scale. We
included a smearing estimator in log-linear models to account for retransformation bias.