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Study Explores Patient Outcomes in Hospitalist Model

No mortality difference seen in inpatients cared for by hospitalists, internists or family practice physicians

WEDNESDAY, Dec. 19 (HealthDay News) -- Patients hospitalized with common medical conditions who are cared for by hospitalists do not have improved mortality rates or readmission rates compared to those treated by general internists or family practice physicians, according to the results of a study published in the Dec. 20 issue of the New England Journal of Medicine. However, care by a hospitalist is associated with modestly shorter hospital stays compared to traditional models.

Peter K. Lindenauer, M.D., of Tufts University in Boston, and colleagues analyzed data from 76,926 patients hospitalized at 45 U.S. hospitals for seven common medical conditions (pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, chronic obstructive pulmonary disease, or myocardial infarction) to compare outcomes of those cared for by hospitalists (n=284), general internists (n=993) and family physicians (n=971).

Compared to that of general internists, care by a hospitalist was associated with modestly shorter hospital stays and lower costs, but similar inpatient mortality and 14-day readmission rates. Compared to that of family physicians, care by a hospitalist was associated with shorter length of stay, but costs, inpatient mortality and readmission rates did not differ.

The author of an accompanying editorial discusses methodologic problems of the study, such as lack of adjustment for case-mix, and encourages further study of the hospitalist movement. "New investigations should focus on quality improvement, comparative effectiveness, clinical informatics, the safety of patients, and the translation of new medical advances to clinical practice."

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