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Hospitalist Care Offers Modest Advantages
Although the hospitalist model is rapidly altering inpatient care-an estimated 29% of American hospitals have hospitalists on staff and more than 12,000 hospitalists practice in the United States-little information about the clinical and economic outcomes of care by hospitalists is available.
Although the hospitalist model is rapidly altering inpatient care-an estimated 29% of American hospitals have hospitalists on staff and more than 12,000 hospitalists practice in the United States-little information about the clinical and economic outcomes of care by hospitalists is available. To address this, Peter K. Lindenauer, MD, and colleagues at the Center for Quality and Safety Research, Baystate Medical Center, Springfield, Mass, and Tufts University School of Medicine, Boston, conducted a retrospective cohort study of 76,926 patients aged 18 years and older who were hospitalized between September 2002 and June 2005. Findings were published in the December 20 issue of the New England Journal of Medicine.
The patients (mean age, 69 years; 57% women) were admitted at 45 US hospitals for pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of chronic obstructive pulmonary disease, or acute myocardial infarction. The researchers used multivariate models to compare the outcomes of care by 284 hospitalists, 993 general internists, and 971 family physicians.
Compared with patients cared for by general internists, patients cared for by hospitalists had a modestly shorter hospital stay (0.4 day shorter) and slightly lower costs ($268 per day lower). The inpatient death rate and 14-day readmission rate were similar for patients of general internists and hospitalists.
The researchers also reported that compared with patients cared for by family physicians, those cared for by hospitalists also had a shorter stay (0.4 day shorter). Inpatient death rates and 14-day readmission rates were similar for the 2 specialties. However, the cost savings associated with hospitalist care ($125 per day) were not statistically significant from those associated with care provided by family physicians.
The lack of clear cost savings despite more than a 10% reduction in length of stay suggests that compared with other physicians, hospitalists may compress the same or even higher numbers of tests and treatments into shorter periods, according to the researchers.
