New studies back effectiveness of hospitalists

Researchers are doing more analyses on how these specialists influence patient care.

By Damon Adams — Posted Sept. 13, 2004

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Patients treated by hospitalists had shorter hospital stays and paid less for hospital services than patients treated by non-hospitalists, a new study shows.

Patients cared for by hospitalists averaged one day less in the hospital and had a 10% reduction in costs. Researchers said the Iowa study adds to a growing body of research showing the effectiveness of hospitalist care.

"It does support previous studies that show an increase in efficiency [by hospitalists]. Getting patients out sooner opens that bed that much sooner for the next person," said Peter Kaboli, MD, lead study author and assistant professor at the University of Iowa Roy J. and Lucille A. Carver College of Medicine.

Researchers analyzed 1,706 patient admissions in 2000-01 to the four general internal medicine services at the University of Iowa Hospitals and Clinics. One service was staffed by hospitalists, the other three by non-hospitalist internists.

The research was conducted by the Dept. of Veterans Affairs Iowa City Health Care System and the University of Iowa. The study appeared in the August American Journal of Managed Care.

The study found that patients treated by hospitalists averaged one day less in the hospital than those treated by non-hospitalists (5.5 days compared with 6.5 days). Hospitalization costs averaged $917 less for the patients of hospitalists.

Among the cost savings, nursing costs were $604 less for patients of hospitalists and lab costs were $126 less. The lower nursing cost likely was a result of the shorter hospital stay.

Lower lab costs were attributed to either more prudent use of lab testing or the shorter length of stay, the study said. Dr. Kaboli said hospitalists were efficient because they were familiar with the hospital environment and knew the system.

Studies also probe acceptance

Hospitalists said they weren't surprised by the findings.

"It's fairly consistent to what we've seen before, and that's that hospitalists save money. People are feeling like this is potentially a better way of taking care of patients," said Andrew Auerbach, MD, a hospitalist and assistant professor of medicine at the University of California, San Francisco, School of Medicine.

Another recent study showed the effectiveness of hospitalists: A study in the July 6 Annals of Internal Medicine found that teams of hospitalists and orthopedic surgeons reduced minor postoperative complications in older patients having elective hip or knee surgery.

Meanwhile, researchers are conducting studies to gauge the impact and acceptance of hospitalists. A multicenter study on hospitalists, which involves Dr. Kaboli, is looking at how hospitalists influence care.

A study of Boston internists in the Oct. 27, 2003, Archives of Internal Medicine found that physicians' attitudes toward a voluntary hospitalist program improved. In the study, led by Dr. Auerbach, physician attitudes changed after the hospitalist program was started and more doctors said using a hospitalist service improved quality of care. Doctors also reversed previous views that a hospitalist service adversely affected the physician-patient relationship.

Older doctors were more likely to favor the hospitalist program while doctors with busier inpatient practices were more negative.

A 2000 article in the American Journal of Medicine said physicians with initial concerns about hospitalists and quality of care usually accept the system after implementation.

"It's very clear that hospitalists are going nowhere but up. The hospitalist is a permanent fixture in patient settings across the United States right now," Dr. Auerbach said.

About 1,800 hospitals use hospitalists, with about seven hospitalists per hospital, said Laurence Wellikson, MD, executive director of the Society of Hospital Medicine, which represents hospitalists. He estimates there are 10,000 hospitalists, a number the society expects to grow to about 30,000 by the end of the decade.

"Hospitalists are getting asked to do more and more," Dr. Wellikson said.

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External links

"Associations with Reduced Length of Stay and Costs on an Academic Hospitalist Service," The American Journal of Managed Care, August (link)

Society of Hospital Medicine (link)

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