The impact of hospitalists on length of stay and costs: systematic review and meta-analysis

Am J Manag Care. 2012 Jan 1;18(1):e23-30.


Background: Hospital medicine has undergone remarkable growth since its creation. Most (but not all) of the published literature demonstrates better outcomes for patients cared for by hospitalists.

Purpose: We performed a systematic review and meta-analysis to estimate the magnitude of the impact of hospitalists on length of stay (LOS) and cost.

Data sources: Medline/PubMed.

Study selection: Articles published through February 2011 comparing outcomes (LOS and/or cost) of hospitalists with others.

Data extraction: Two reviewers independently searched for abstracted information. We also contacted individual authors to provide us with missing data.

Data synthesis: We used a random-effects model.

Results: A total of 502 abstracts were initially identified and 17 studies of 137,561 patients were included in the final analysis. LOS was significantly shorter in the hospitalist group compared with the non-hospitalist group, with a mean difference of -0.44 days (95% confidence interval [CI] -0.68 to -0.20, P < .001). In studies that compared a (non-resident) hospitalist service with a (non-resident) non-hospitalist service, LOS was also significantly shorter in the hospitalist group (mean difference -0.69 days [95% CI -0.93 to -0.46, P < .001]). Cost was not found to be significantly different (11 studies). There was significant heterogeneity between studies and we found no evidence of publication bias.

Conclusions: Despite its limitations, our analysis supports the conclusion that hospitalists significantly reduce LOS without increasing costs. These findings can be used to define and measure expectations of performance for hospital medicine groups.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Hospital Costs / trends*
  • Hospitalists* / economics
  • Humans
  • Length of Stay / trends*