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Quality and Cost of Care by Family Physicians vs. Hospitalists
Am Fam Physician. 2008 Jul 15;78(2):262.
Background: More than one half of U.S. hospitals with 200 beds or more have hospitalists on staff, who are focused solely on inpatients. They can be available quickly, develop clinical and logistical expertise, and offer convenience and efficiency, allowing family physicians to focus on outpatient productivity. However, the hospitalist model requires transfer of care at admission and discharge. There is also the potential for ordering excessive diagnostic tests because hospitalists are not as familiar with the patient's history. Lindenauer and colleagues conducted a retrospective cohort study to evaluate the outcomes for patients treated by hospitalists, general internists, and family physicians in a variety of practice settings.
The Study: The authors measured health care use and quality of care for adults admitted to the hospital for pneumonia, exacerbation of chronic obstructive pulmonary disease, ischemic stroke, chest pain, acute myocardial infarction, heart failure, or urinary tract infection. They compared length of stay, cost, in-hospital deaths, and all-cause readmission rates in patients cared for by family physicians, general internists, and hospitalists. The study was conducted from September 1, 2002, to June 30, 2005, and included 76,926 patients from 45 hospitals. Approximately one fourth of the hospitals were teaching hospitals. The patients were cared for by 284 hospitalists, 993 general internists, and 971 family physicians. Family physicians had lower volumes of inpatients than hospitalists.
Results: After adjusting for principal diagnosis, patient characteristics, hospital characteristics, and case volume, the authors found a shorter hospital stay of 0.4 days in patients cared for by hospitalists compared with those cared for by general internists and family physicians. The readmission and death rates were similar. Fourteen-day readmission rates were 6.3 percent with hospitalists, 6.9 percent with general internists, and 6.7 percent with family physicians, whereas in-hospital death rates were 4.3, 4.5, and 4.1 percent, respectively. Cost of care was similar in hospitalists and family physicians, with mean costs ranging from $7,077 per case with family physicians to $8,078 with hospitalists. Substantially similar results were obtained when results were not adjusted for case volume or teaching status of the hospital.
Conclusion: The authors conclude that, compared with family physicians, hospitalists reduce the length of stay by less than one half of a day, with similar death, readmission, and cost in patients with common diagnoses.
Lindenauer PK, et al. Outcomes of care by hospitalists, general internists, and family physicians. N Engl J Med. December 20, 2007;357(25):2589–2600.
Copyright © 2008 by the American Academy of Family Physicians.
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