Patients at an academic medical center who are cared for by a hospital-based general physician may have a shorter length of hospital stay than those who are not, especially if the patients require close monitoring or complex discharge planning, according to a report in the Sept. 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Pressure to control costs has led more academic medical centers to hire hospital-based physicians, known as hospitalists, according to background information in the article. These clinicians provide care for medical inpatients and staff medical teaching rounds.
William N. Southern, M.D., M.S., and colleagues at Montefiore Medical Center, the University Hospital for Albert Einstein College of Medicine, New York, reviewed data on all patients discharged from a 381-bed teaching hospital between July 1, 2002, and June 30, 2004. The patients were assigned to either a hospitalist or non-hospitalist team by a senior admitting resident at the time of admission. The teams were identical except for the type of physician conducting the rounds. Data on the patients' demographics, insurance status, health history, diagnosis, length of stay, readmission and death were gathered form the hospital's clinical information system.
During the study period, there were 9,037 discharges with sufficient data to be included in the analysis. Of these, 2,913 (32.2 percent) were cared for by hospitalists teams and 6,124 (67.8 percent) were cared for by non-hospitalist teams. The average length of stay in the hospitalist group was 5.01 days, compared with 5.87 days in the non-hospitalist group. There were no differences between the two groups in readmission or death rate in the hospital or within 30 days.
"Hospitalist care had the strongest association with length of stay in patients with specific diagnoses, including cerebrovascular accidents (strokes), congestive heart failure, pneumonia, sepsis, urinary tract infections and asthma/chronic obstructive pulmonary disease," the authors write. "The close monitoring and continuous presence offered by hospitalists may allow for earlier discharge because hospitalists are more likely to detect clinical improvement in real time and to make appropriate adjustments in treatment regimens."
Hospitalist care was also more strongly associated with shorter length of stay in patients who had complex discharge planning needs, such as home health care services, rehabilitation or transfer to a nursing facility. "We were able to measure discharge planning needs with the use of a separate discharge disposition code, which was assigned independent of billing at the time of discharge," the authors write. "We believe that the greater reduction in length of stay associated with complex discharge planning reflects hospitalist skills in working with ancillary staff, such as social workers or discharge planners."
(Arch Intern Med. 2007;167(17):1869-1874. Available pre-embargo to the media at www.jamamedia.org.)
This study was supported by the Institute for Medical Effectiveness Research, a joint project of the Albert Einstein College of Medicine and the North Shore-Long Island Jewish Health System, and the Clinical Investigation Core of the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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