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Hospital medicine is the fastest-growing specialty in the U.S., with more than 20,000 hospitalists practicing in 2007. Earlier studies on the value of hospitalists were small and from single institutions; in a new retrospective cohort study, investigators evaluated patient outcomes generated by a large number of hospitalists, general internists, and family physicians in a variety of practice settings.
The study included 76,926 adult patients who were discharged with principal diagnoses of pneumonia, heart failure, chest pain, acute myocardial infarction, ischemic stroke, urinary tract infection, or acute exacerbation of chronic obstructive pulmonary disease from 45 U.S. hospitals. Compared with patients of general internists, patients of hospitalists had significantly shorter hospital stays (5.2 vs. 4.7 days) and significantly lower costs (by US$268). Inpatient death rates and 14-day admission rates were similar in the two groups. Compared with family physicians’ patients, hospitalists’ patients had significantly shorter lengths of stay (5.2 vs. 4.8 days), but costs, death rates, and 14-day readmission rates were similar in the two groups.
Lindenauer PK et al. Outcomes of care by hospitalists, general internists, and family physicians. N Engl J Med 2007 Dec 20; 357:2589.
McMahon LF Jr. The hospitalist movement — Time to move on. N Engl J Med 2007 Dec 20; 357:2627.
Comment
In this large study, the hospitalist model was associated with a shorter length of stay, without having adverse effect on rates of readmission or death. Hospitalist care also was slightly less expensive than care provided by general internists. This study’s results validate the hospitalist model, and I agree with the editorialist: The field of hospital medicine is here to stay, so we need to move past studies of costs and outcomes and focus on relevant patient care and systems questions, such as comparative effectiveness, patient safety, and quality improvement.