All ETDs from UAB

Advisory Committee Chair

S Robert Hernandez

Advisory Committee Members

Nancy Borkowski

Jeff M Szychowski

Stephen Walston

Document Type

Dissertation

Date of Award

2017

Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions

Abstract

Environmental pressures in the healthcare industry force hospitals to seek new innovations to become more efficient. Hospitals have entered into a partnership hospitalists in an effort to reduce their ALOS. The purposes of this study are to determine the impact of ALOS by hospitals using hospitalists, the sustainability of impact on ALOS over time, and whether hospitals that adopted the hospitalist innovation in the last five years experienced an impact on ALOS. The study investigated 26,527 observations of hospital-years of nonprofit and investor-owned hospitals from 2007-2015 that responded to the AHA Annual Survey and primarily provided general medical/surgical services. Case mix was obtained from CMS. The hypotheses studied hospitals with hospitalists and hospitals with hospitalists/intensivists in an attempt to capture the comprehensive hospitalist population. Intensivists refer to medical/surgical and cardiac intensivists. Multivariable GEE analyses using repeated measures assessed whether hospitals utilizing hospitalists have a lower ALOS as compared to hospitals not utilizing hospitalists. Trendlines were used to observe whether hospitals with hospitalists sustained a lower ALOS over time. Multivariable GEE analyses with interaction measured the impact on ALOS experienced by late adopters of the hospitalist innovation in comparison to prior adopters. The results supported four of six hypotheses. Multivariable GEE analyses revealed that hospitals with hospitalists and hospitalists/intensivists reported a lower ALOS (β=-0.080, p=.006) and (β=-0.076, p=.014), respectively. A quadratic curve was used to fit the trendlines that showed a decline in ALOS, with the lowest point occurring in 2012. Multivariable GEE analyses with interaction revealed that hospitals adopting the hospitalist and hospitalist/intensivist innovation from 2011-2015 experienced no statistically significant association (p=0.501 and p=0.440, respectively) with ALOS. This study affirms that hospitals with hospitalists experienced lower ALOS than their non-hospitalist counterparts and sustained a lower ALOS over time. Hospitalists have developed a clinical expertise through their continual presence at the hospital and familiarity with the hospital environment. The findings suggest that hospitals have leveraged their partnership with hospitalists to help gain competitive advantage, as described by RBV theory. Late adopters who embraced the hospitalist innovation due to mimetic behavior experienced no setback in ALOS as compared to prior adopters.

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