Patients being treated by a hospitalist went home nearly half a day earlier than those seen by an internist or family physician, according to a Dec. 20 New England Journal of Medicine report comparing the outcomes and costs of care for almost 77,000 patients treated at 45 hospitals between September 2002 and June 2005.
The average cost for all patients was $7,796. But, the 0.4-day shorter length of stay for the 24,772 patients seen by the 284 hospitalists translated into a hospital bill that was $268 cheaper than the bill for the 33,341 patients seen by 993 internists and $125 cheaper than what was charged the 18,813 patients seen by 971 family physicians. Death and 14-day readmission rates were similar.
Joseph Miller, senior vice president of the Society for Hospital Medicine, said previous studies had shown higher reductions in length of stayupward of 15% compared to the 12% in this current studybut noted this study included a larger number of hospitals and the patients studied only included those who were admitted for seven of the most common conditions. These are pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of chronic obstructive pulmonary disease, and heart attack.
If patients with more complex conditions had been studied, Miller predicted that the differences in lengths of stay and outcomes would have been more significant. For every day the patient is in the hospital, there is more potential impact for what the hospitalist does, he explained.
The researchers, however, noted thatwhile those seven conditions are extremely commonthey make up a relatively small percentage of the annual caseload for physicians who care for hospitalized patients. -- by Andis Robeznieks