Use Of Hospitalists Could Lead To More Efficient Care, Modest Cost Reductions, According To Report

Main Category: Public Health
Also Included In: Primary Care / General Practice
Article Date: 21 Dec 2007 - 12:00 PDT

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Hospitalists -- physicians who provide general care to patients in hospitals in place of traditional general practitioners and internists -- reduce the average inpatient stay by 12% and create modest savings, according to a study published Thursday in the New England Journal of Medicine, the Wall Street Journal reports (Levitz, Wall Street Journal, 12/20). Lead author Peter Lindenauer, an associate professor at Massachusetts' Baystate Medical Center, and colleagues examined health records between 2002 and 2005 of about 80,000 patients at 45 unnamed hospitals located in the Southeast region of the U.S. The patients were treated for seven common conditions, including pneumonia, chest pain, heart attack and stroke.

Patients treated by hospitalists on average were discharged from hospitals about 9.6 hours earlier than those treated by their regular physicians. Hospitalist patients received medical bills of $5,129 -- about 2.4% to 5% lower than medical bills totaling $5,254 to $5,397 among patients treated by regular doctors. The researchers found that hospitalist patients within two weeks of being discharged returned to the hospital or died because of health complications at about the same rate as patients who were being treated by regular physicians (LaMendola, South Florida Sun-Sentinel, 12/20).

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While the study did not assess quality of care, Lindenauer said one of the "disadvantages" of the hospitalist model is that it "introduces a handoff between doctors," adding, "The primary care doctor is caring for you in your office; then they refer you to the hospitalist for hospital care, then at the conclusion, the hospital refers you back to primary care." He added that a potential benefit of being treated by hospitalists is that they are present all day and are able to make medical decisions in "real time" (Wall Street Journal, 12/20).

Groups that oppose the use of hospitalists, including some medical associations and Families USA, say they replace regular physicians at an important stage of care and move patients out of the hospital too quickly, the Sun-Sentinel reports (South Florida Sun-Sentinel, 12/20). According to the Journal, experts say that as the "field grows, there needs to be an emphasis on improving efficiency, such as better communications between primary-care doctors and hospitalists" (Wall Street Journal, 12/20).

The study is available online.

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