833 The Impact of Trainee Physician Experience on Costs and Treatment Outcomes Among Patients Hospitalized With Ulcerative Colitis

Abstract

INTRODUCTION/AIM: The efficiency and the delivery of care have been at the center of the current healthcare debate and reform. We sought to investigate the “July effect” on resource utilization among patients admitted to teaching hospitals with ulcerative colitis. METHODS: This was a retrospective cohort study using the 2016 Nationwide Inpatient Sample (NIS), the largest public inpatient database in the US. Patients with a principal diagnosis of Ulcerative colitis (UC) were included. Patients were excluded if they were younger than 18 years or treated at non-teaching hospital. The primary outcome was total hospitalization charges associated with the hospital admission for UC. Secondary outcomes were 1) length of stay 2) in-hospital mortality and 3) surgical intervention. Patient outcomes at the start of the academic year (July- September) were compared with those at the end of the academic year (April -June). Proportions were compared using fisher’s exact test and continuous variables using student t- test. Multivariate analysis was used to adjust for gender, age, Charlson Comorbidity Index, income in patient zip code, hospital region, location, size and teaching status. RESULTS: 24,650 patients were included in the study. The mean age was 46 years and 54% were females. Compared with patients admitted in July/August/September, those admitted in April/May/June had an adjusted mean difference in total hospitalization charges of 7,380$, (95% Confidence Interval (CI: $14,160 - $599, P = -0.03). Similar results were obtained for Length of Stay: Compared with patients admitted in July/August/September, those admitted in April/May/June, had an adjusted mean difference in length of stay of 0.7 days, CI: 1.3 -0.1, P = 0.02. There was no statistically significant difference in in-hospital mortality rate (adjusted odds ratio (aOR): 0.60, CI: 0.13-2.80, P = 0.51) or surgery rate (aOR: 0.91, CI: 0.59- 1.40, P = 0.68) among the two patient groups. CONCLUSION: The experience of the physician in training affects efficiency of care among patients admitted to the hospital with ulcerative colitis, but does not seem to impact treatment outcomes including in-hospital mortality and colectomy rate.