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Acute Care/Hospitalization

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Hospitalists can reduce hospital stays and costs for children with common pediatric conditions like asthma

The majority of studies of hospitalists, hospital-based physicians (usually internists) who specialize in the care of hospitalized patients, have been conducted in hospitals that generally treat patients with complex conditions. However, half of children's admissions occur in nonteaching community hospitals. A new study found that use of hospitalists in this setting resulted in earlier discharges and reduced costs for children suffering from asthma and dehydration. These findings suggest that hospitalists can increase efficiency and reduce costs for children hospitalized for common pediatric conditions, concludes Christopher P. Landrigan, M.D., M.P.H., of Children's Hospital Boston.

The researchers retrospectively examined the outcomes of children in a staff-model HMO (HMO 1) and nonstaff model HMO (HMO 2), who were treated at a children's hospital for asthma, dehydration, or viral illness between October 1993 and July 1998. HMO 1 had introduced a hospitalist system in October 1996. Overall, 1,970 children were cared for in HMO 1 and 1,001 in HMO 2.

After the hospitalist system was introduced in HMO 1, length of hospital stay was reduced by 0.23 days (13 percent) for asthma and 0.19 days (11 percent) for dehydration. There was no difference for patients with viral illness.

The largest relative reduction in length of stay occurred in patients with a shorter length of stay whose hospitalizations were reduced from 2 days to 1 day. The shift to a hospitalist system resulted in an average cost-per-case reduction of $105.51 (9.3 percent) for patients with asthma and $86.22 (7.8 percent) for patients with dehydration. During the same period, length of stay and total cost rose in HMO 2.

The study was supported in part by the Agency for Healthcare Research and Quality (HS13333).

More details are in "Impact of a hospitalist system on length of stay and cost for children with common conditions," by Rajendu Srivastava, M.D., F.R.C.P., M.P.H., Dr. Landrigan, Dennis Ross-Degnan, Sc.D., and others, in the August 2007 Pediatrics 120(2), pp. 267-274.

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