Health Care Delivery

Patients of general internists and hospitalists tend to have shorter hospital stays

Hospitalists—physicians who usually care for patients only while they are hospitalized—have grown to number almost 6,000 nationwide and are projected to increase to more than 10,000 in the next 10 years. Hospitalists tend to be more efficient than other physicians in providing inpatient care to general medical patients, and general internists appear to be more efficient than endocrinologists and rheumatologists, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS11540). Such efficiency translates to shorter hospital stays and lower costs, concludes Sanjay Saint, M.D., M.P.H., of the University of Michigan Health System.

Dr. Saint and his colleagues analyzed 2,617 admissions to the general medicine service of the University of Michigan Hospitals from July 2001 to June 2002. They examined the impact of internal medicine specialty and physician experience on hospital length of stay (LOS), total hospital costs, and patient outcomes (hospital death and readmission rates).

Adjusted mean LOS was 0.56 days greater for rheumatologists and 0.38 days greater for endocrinologists compared with general internists. Total costs for patients cared for by general internists were $1,100 lower than for patients treated by endocrinologists and $431 lower than for patients cared for by rheumatologists. Hospitalists and physicians in the top two deciles of recent inpatient general medical experience showed significantly reduced LOS compared with other physicians (0.31 and 0.35 days lower, respectively). There were no significant differences in readmission rates or in-hospital deaths among the various physician groups, suggesting similar patient outcomes regardless of resource use.

See "What effect does inpatient physician specialty and experience have on clinical outcomes and resource utilization on a general medical service?" by Vikas Parekh, M.D., Dr. Saint, Scott Furney, M.D., and others, in the May 2004 Journal of General Internal Medicine 19, pp. 395-401.

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