Acute Care/Hospitalization

Hospitalists and general internists provide similar quality of care for patients with congestive heart failure

Some research has suggested that the use of hospitalists to integrate inpatient treatment can reduce cost and length of a hospital stay without increasing readmissions or reducing patient satisfaction. A new study found that hospitalists did not improve the quality of care received by patients with congestive heart failure when compared with care provided by general internists. However, hospitalists' patients were nearly twice as likely to have a 30-day followup.

The researchers used retrospective data from the Multicenter Hospitalist Study, which tracked all 31,000 patients admitted to 6 academic medical centers over a 2-year period. Of the 372 patients with acute congestive heart failure, hospitalists cared for 120 patients and nonhospitalists cared for 252 patients. Each group of patients had comparable odds of assessment of left ventricular ejection fraction (a measure of the heart's pumping power), of treatment with an angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker, or of beta-blocker prescription. However, patients treated by hospitalists were almost twice as likely as patients of internists to have a 30-day followup after release from the hospital, a significant difference.

There were no significant differences in the two groups regarding other quality measures examined: frequency of cardiac testing, length of hospital stay, costs, or risk for hospital readmission or death by 30 days after discharge. Although academic hospitalists and internists provide similar quality of care for heart failure patients, hospitalists seem to pay more attention to longitudinal (that is, followup) care, conclude the researchers.

The study was funded in part by the Agency for Healthcare Research and Quality (HS10597 and HS11416). More details are in "Quality of care for decompensated heart failure: Comparable performance between academic hospitalists and non-hospitalists," by Eduard E. Vasilevskis, M.D., David Meltzer, M.D., Ph.D., Jeffrey Schnipper, M.D., M.P.H., and others in the September 2008 Journal of General Internal Medicine 23(9), pp. 1399-1406.

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