Comparison of Hospital Costs and Length of Stay for Community Internists, Hospitalists, and Academicians

BACKGROUND: The model of inpatient medical management has evolved toward Hospitalists because of greater cost efficiency compared to traditional practice. The optimal model of inpatient care is not known. OBJECTIVE: To compare three models of inpatient Internal Medicine (traditional private practice Internists, private Hospitalist Internists, and Academic Internists with resident teams) for cost efficiency and quality at a community teaching hospital. DESIGN: Single-institution retrospective cohort study. MEASUREMENTS AND MAIN RESULTS: Measurements were hospital cost, length of stay (LOS), mortality, and 30-day readmission rate adjusted for severity, demographics, and case mix. Academic Internist teams had 30% lower cost and 40% lower LOS compared to traditional private Internists and 24% lower cost and 30% lower LOS compared to private Hospitalists. Hospital mortality was equivalent for all groups. Academic teams had 2.3–2.6% more 30-day readmissions than the other groups. CONCLUSIONS: Academic teams compare favorably to private Hospitalists and traditional Internists for hospital cost efficiency and quality

A Controlled Investigation of Optimal Internal Medicine Ward Team Structure at a Teaching Hospital

BACKGROUND: The optimal structure of an internal medicine ward team at a teaching hospital is unknown. We hypothesized that increasing the ratio of attendings to housestaff would result in an enhanced perceived educational experience for residents. METHODS: Harbor-UCLA Medical Center (HUMC) is a tertiary care, public hospital in Los Angeles County. Standard ward teams at HUMC, with a housestaff∶attending ratio of 5:1, were split by adding one attending and then dividing the teams into two experimental teams containing ratios of 3:1 and 2:1. Web-based Likert satisfaction surveys were completed by housestaff and attending physicians on the experimental and control teams at the end of their rotations, and objective healthcare outcomes (e.g., length of stay, hospital readmission, mortality) were compared. RESULTS: Nine hundred and ninety patients were admitted to the standard control teams and 184 were admitted to the experimental teams (81 to the one-intern team and 103 to the two-intern team). Patients admitted to the experimental and control teams had similar age and disease severity. Residents and attending physicians consistently indicated that the quality of the educational experience, time spent teaching, time devoted to patient care, and quality of life were superior on the experimental teams. Objective healthcare outcomes did not differ between experimental and control teams. CONCLUSIONS: Altering internal medicine ward team structure to reduce the ratio of housestaff to attending physicians improved the perceived educational experience without altering objective healthcare outcomes

Oxygen detection system consisting of a millimeter wave Fabry-Pérot resonator and an integrated SiGe front-end

Oxygen shows significant absorption lines in the millimeter wave spectrum. Resonators are widely used to achieve a strong absorption even with a short absorption paths length for concentration measurements. A sensor system based on a Fabry-Pérot resonator for oxygen measurements at ambient pressure is presented here. The Fabry-Pérot resonator consists of two metal mirrors with a diameter of 50 mm. For purpose of oxygen detection the resonator covers a frequency range between 55 GHz and 65 GHz with a resonant peak density between 1 GHz and 1.5 GHz, depending on the mirror distance, and a quality factor of approximately 7000. To achieve a compact sensor system the concept envisages two integrated transceiver circuits directly coupling to coaxial ports in the metal mirrors of the resonator. The integrated SiGe front-end addresses a frequency band from 50 GHz to 75 GHz. They are realized as heterodyne structures with integrated directional couplers, thus it is possible to measure scattering parameters. For first oxygen concentration measurements, the resonator sample was coupled to a commercially available Vector Network Analyzer. The cavity was filled with oxygen concentrations of 0% vol. and 20% vol. at ambient pressure and temperature resulting in a significant change of the quality factor for frequencies close to the oxygen absorption line at 60.6 GHz. The sensor does not contain hot components. This is an advantage compared to other oxygen sensors, like electrochemical or metal-oxide sensors