Outcomes of care by hospitalists, general internists, and family physicians. The New England journal of medicine [N Engl J Med] Journal article | | Title | Outcomes of care by hospitalists, general internists, and family physicians. | | Author(s) | Lindenauer PK, Rothberg MB, Pekow PS, Kenwood C, Benjamin EM, Auerbach AD | | Institution | Center for Quality and Safety Research, Baystate Medical Center, Springfield, MA 01199, USA. peter.lindenauer@bhs.org | | Source | N Engl J Med 2007 Dec 20; 357(25):2589-600. | | MeSH | Adult
Aged
Aged, 80 and over
Cohort Studies
Family Practice
Female
Health Care Costs
Hospital Mortality
Hospitalists
Hospitalization
Humans
Internal Medicine
Length of Stay
Male
Middle Aged
Models, Statistical
Multivariate Analysis
Outcome Assessment (Health Care)
Regression Analysis
Retrospective Studies
| | Abstract | BACKGROUND: The hospitalist model is rapidly altering the landscape for inpatient care in the United States, yet evidence about the clinical and economic outcomes of care by hospitalists is derived from a small number of single-hospital studies examining the practices of a few physicians.
METHODS: We conducted a retrospective cohort study of 76,926 patients 18 years of age or older who were hospitalized between September 2002 and June 2005 for pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of chronic obstructive pulmonary disease, or acute myocardial infarction at 45 hospitals throughout the United States. We used multivariable models to compare the outcomes of care by 284 hospitalists, 993 general internists, and 971 family physicians.
RESULTS: As compared with patients cared for by general internists, patients cared for by hospitalists had a modestly shorter hospital stay (adjusted difference, 0.4 day; P<0.001) and lower costs (adjusted difference, $268; P=0.02) but a similar inpatient rate of death (odds ratio, 0.95; 95% confidence interval [CI], 0.85 to 1.05) and 14-day readmission rate (odds ratio, 0.98; 95% CI, 0.91 to 1.05). As compared with patients cared for by family physicians, patients cared for by hospitalists had a shorter length of stay (adjusted difference, 0.4 day; P<0.001), and the costs (adjusted difference, $125; P=0.33), rate of death (odds ratio, 0.95; 95% CI, 0.83 to 1.07), and 14-day readmission rate (odds ratio, 0.95; 95% CI, 0.87 to 1.04) were similar.
CONCLUSIONS: For common inpatient diagnoses, the hospitalist model is associated with a small reduction in the length of stay without an adverse effect on rates of death or readmission. Hospitalist care appears to be modestly less expensive than that provided by general internists, but it offers no significant savings as compared with the care provided by family physicians. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
| | PubMed ID | 18094379 |
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