Compared to traditional family physicians, care provided by hospitalists was associated with significantly lower adjusted in-hospital mortality (OR 0.881 for FP-trained and OR 0.355 for GIM-trained).
Observational (n=34,524)
No
Does care by hospitalists improve in-hospital mortality, 30-day readmission, and length of stay in adult medical inpatients compared to traditional physician providers?
Implementation of a hospitalist program in a Canadian community hospital was associated with lower in-hospital mortality and 30-day readmission rates compared to traditional family physicians.
Odds Ratio: 0.881 (95% CI 0.779–0.996)
Tasa de eventos absoluta: 14% vs 13.2%
valor p: p=0.043
BACKGROUND: Despite the growth of hospitalist programs in Canada, little is known about their effectiveness for improving quality of care and use of scarce healthcare resources. The objective of this study is to compare measures of cost and quality of care (in-hospital mortality, 30-day same-facility readmission, and length of stay) of hospitalists vs. traditional physician providers in a large Canadian community hospital setting. METHODS: We performed a retrospective analysis of data from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database, using multivariate logistic and linear regression analyses comparing performance of four provider groups of traditional family physicians (FPs), traditional internal medicine subspecialists (other-IM), family physician-trained hospitalists (FP-Hospitalist), and general internal medicine-trained hospitalists (GIM-Hospitalist). RESULTS: Compared to traditional FPs, FP-Hospitalists and GIM-Hospitalists demonstrate lower mortality OR 0.881, (CI 0.779 - 0.996); and OR 0.355, (CI 0.288 - 0.436) and readmission rates OR 0.766, (CI 0.678 - 0.867); and OR 0.800, (CI 0.675 - 0.948). Compared to traditional FPs, GIM-Hospitalists appear to improve length of stay OR-2.975, (CI -3.302 - -2.647) while FP-Hospitalists perform similarly OR 0.096, (CI -0.136 - 0.329). Compared to other-IM, GIM-Hospitalists have similar performance on all measures while FP-Hospitalists show a mixed impact. CONCLUSIONS: Compared to traditional family physicians, hospitalists appear to improve measures of quality and resource utilization. Specifically, hospitalists demonstrate lower in-hospital mortality and 30-day readmission rates while improving (or at least showing similar) length of stay. Compared to traditional subspecialists, hospitalists demonstrate similar performance despite looking after sicker and more complex medical patients.
Yousefi et al. (Wed,) conducted a observational in General medical inpatients (n=34,524). Hospitalist care (FP-Hospitalists and GIM-Hospitalists) vs. Traditional care providers (traditional family physicians and internal medicine subspecialists) was evaluated on In-hospital mortality (FP-Hospitalist vs Traditional FP) (OR 0.881, 95% CI 0.779-0.996, p=0.043). Compared to traditional family physicians, care provided by hospitalists was associated with significantly lower adjusted in-hospital mortality (OR 0.881 for FP-trained and OR 0.355 for GIM-trained).