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December 19, 2007New England Journal of Medicine238 citations

Outcomes of Care by Hospitalists Compared to General Internists and Family Physicians

Outcomes of Care by Hospitalists, General Internists, and Family Physicians

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Why the study?

Does care by hospitalists improve clinical and economic outcomes compared to care by general internists or family physicians in hospitalized adults?

Population

76,926 patients 18 years of age or older hospitalized between September 2002 and June 2005 for pneumonia…

Comparison

Care provided by hospitalists (n=284) vs Care provided by general internists or family…

Design

Cohort

Follow-up

Inpatient and 14 days post-discharge

Key result

Care by hospitalists was associated with a shorter length of stay (adjusted difference 0.4 day; P<0.001) but similar inpatient death rates (OR 0.95; 95% CI 0.85-1.05) compared to general internists.

Authors

PLPeter K. LindenauerMRMichael B. RothbergPPPenelope S. Pekow

Discussion

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Overview

Shorter LOS with hospitalists may inform staffing without mortality risk; leaves open causality and generalizability pending randomized trials.

Key Points

  • This study aims to compare clinical and economic outcomes of care provided by hospitalists, general internists, and family physicians.
  • Conducted a retrospective cohort study of 76,926 hospitalized patients over 45 hospitals in the US.
  • Patient diagnoses included pneumonia, heart failure, chest pain, among others, from September 2002 to June 2005.
  • Using multivariable models to compare outcomes across 284 hospitalists, 993 general internists, and 971 family physicians.
  • Hospitalist care resulted in a shorter hospital stay by 0.4 days compared to general internists (P<0.001).
  • Hospitalist care led to lower costs than general internists by $268 (P=0.02), but was not significantly different from family physicians ($125; P=0.33).
  • Death rates (OR 0.95; 95% CI 0.85-1.05) and 14-day readmission rates (OR 0.98; 95% CI 0.91-1.05) were similar among all physician types.

Study Design

Type

Cohort (n=76,926)

Multicenter

Yes

Structured PICO

Does care by hospitalists improve clinical and economic outcomes compared to care by general internists or family physicians in hospitalized adults?

P
Population
76,926 patients 18 years of age or older 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.
I
Intervention
Care provided by hospitalists (n=284)
C
Comparator
Care provided by general internists (n=993) or family physicians (n=971)
O
Outcome
Length of hospital stay, costs, inpatient rate of death, and 14-day readmission rate

The hospitalist model is associated with a small reduction in length of stay and modestly lower costs compared to general internists, without adversely affecting mortality or readmission rates.

Main Result

Effect estimate: OR 0.95 (95% CI 0.85-1.05)

Cite This Study

Lindenauer et al. (2007) conducted a cohort in Pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of COPD, or acute myocardial infarction (n=76,926). Care by hospitalists vs. Care by general internists and family physicians was evaluated on Inpatient rate of death (hospitalists vs general internists) (OR 0.95, 95% CI 0.85-1.05). Care by hospitalists was associated with a shorter length of stay (adjusted difference 0.4 day; P<0.001) but similar inpatient death rates (OR 0.95; 95% CI 0.85-1.05) compared to general internists.

synapsesocial.com/papers/6a12777cea48cb855a34e7a2https://doi.org/10.1056/nejmsa067735
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