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Hospitalists and the Costs and Outcomes of Hospital Care
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What is the problem and what is known about it so far?
American doctors have traditionally spent part of their day seeing patients in their offices and part of their day seeing patients in the hospital. However, many hospitals have begun to use doctors called hospitalists. Hospitalists spend a large portion of their time taking care of hospitalized patients. The concept of hospitalists was developed to improve quality and reduce costs. Because of increases in the hospital patients' level of illness and the specialized nature of hospital care, it is difficult for doctors to split their time between the outpatient office and the hospital. It is also difficult to keep up with the huge amount of information relevant to both settings. Doctors are unavailable to hospitalized patients for much of the day if they are seeing patients in the office. Despite the popularity of hospitalists, it remains uncertain whether they actually improve hospital care.
Why did the researchers do this particular study?
To compare patient outcomes and costs for patients cared for by hospitalists and patients cared for by nonhospitalists.
Who was studied?
The researchers studied 6511 adult patients admitted to the general internal medicine service of a teaching hospital between July 1997 and June 1999. The hospitalists were 2 general internists in practice for 2 and 10 years, respectively, who volunteered to become hospitalists. The nonhospitalists were 58 internists who had been in practice for an average of 9 years.
How was the study done?
Every fourth day, patients admitted to the hospital were assigned to a hospitalist. On other days, admitted patients were assigned to nonhospitalists. The researchers compared lengths and costs of hospital stays and the proportion of patients who died 30, 60, and 365 days after leaving the hospital for patients of hospitalists and those of nonhospitalists. The researchers looked for differences overall and in the first and second years of the study.
What did the researchers find?
Patients cared for by hospitalists stayed in the hospital for an average of one third of a day less than patients cared for by nonhospitalists in the first year of the study and about half a day less in the second year. Costs were similar for patients cared for by nonhospitalists and hospitalists in the first year but were $782 lower for hospitalists in the second year. The proportion of patients who died within 30, 60, or 365 days was generally similar for patients cared for by hospitalists and patients cared for by nonhospitalists, except that 4.2% of hospitalists' patients died within 30 days in year 2 compared with 6% of nonhospitalists' patients.
What were the limitations of the study?
This study involved only two hospitalists and a single hospital. The differences found in the patients may reflect differences in the levels of sickness or other patient characteristics rather than the influence of the hospitalists. In addition, the study looked at only a few of the many relevant outcomes of hospital care.
What are the implications of the study?
Patients cared for by hospitalists seem to have shorter and less costly hospital stays and may be less likely to die within 30 days of leaving the hospital than patients cared for by nonhospitalists. However, these findings did not become evident until the second year of the study, suggesting a possible “learning curve” for hospitalists.
Article and Author Information
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The summary below is from the full report titled “Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists.” It is in the 3 December 2002 issue of Annals of Internal Medicine (volume 137, pages 866-874). The authors are D Meltzer, WG Manning, J Morrison, MN Shah, L Jin, T Guth, and W Levinson.
- Copyright ©2004 by the American College of Physicians
