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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.
Source Information
From the Center for Quality and Safety Research, Baystate Medical Center, Springfield, MA (P.K.L., M.B.R., P.S.P., E.M.B.); the Department of Medicine, Tufts University School of Medicine, Boston (P.K.L., M.B.R., E.M.B.); the School of Public Health and Health Sciences, University of Massachusetts, Amherst (P.S.P., C.K.); and the Department of Medicine, University of California at San Francisco, San Francisco (A.D.A.).
Address reprint requests to Dr. Lindenauer at the Center for Quality and Safety Research, Baystate Medical Center, 759 Chestnut St., P-5928, Springfield, MA 01199, or at peter.lindenauer{at}bhs.org.
Related Letters:
Outcomes of Care by Hospitalists
Al-Shaer M. H., Suleiman E. S., Jerome W. P., Chu E. S., Albert R. K., Wei M., van Amerongen D., Lindenauer P. K., Rothberg M. B., Auerbach A. D.
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N Engl J Med 2008;
358:1755-1758, Apr 17, 2008.
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