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The combined effect of the electronic health record and hospitalist care on length of stay.

OBJECTIVES
To assess the combined impact of electronic health record (EHR) adoption and hospitalist care on length of stay (LOS).


STUDY DESIGN
Retrospective cohort study using data from the Healthcare Information and Management Systems Society and a 5% national sample of Medicare beneficiaries. Patients included 20,862 admissions for respiratory disease cared for by hospitalists, and 28,714 admissions for respiratory disease cared for by nonhospitalists in 2985 general and surgical hospitals in the United States.


METHODS
The interaction effect of EHR and hospitalist care on LOS was evaluated using generalized linear models with log-link normal distribution after controlling for patient and hospital characteristics.


RESULTS
In multivariable analyses controlling for patient and hospital characteristics, we found that the reduced LOS associated with complete EHR was 0.166 days and was statistically significant in the hospitals in which 50% or less of patients were cared for by hospitalists. Moreover, we found that reductions in LOS associated with hospitalist care were greater in hospitals that had not adopted a complete EHR. LOS was 0.599 days shorter for patients cared for by hospitalists versus nonhospitalists in hospitals with incomplete EHR adoption; in hospitals with complete EHR adoption, the stay was 0.433 days shorter.


CONCLUSIONS
The reduced LOS associated with hospitalist care is greater than that associated with EHR adoption. However, the combined reduction in LOS with both EHR adoption and hospitalist care may be substantial.