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Hospitalists shorten stays but don't save much money or more lives

Hospitalists are physicians who spend at least a quarter of their time serving as physicians for inpatients and return the patients to their primary care physicians at discharge. An increasing number of U.S. hospitals have adopted the practice of having these physicians on staff. However, a new study finds that while these hospitalists do reduce patients' stay lengths, they don't necessarily save money or reduce death and readmission rates when compared with general internists and family physicians.

Researchers used a database developed to measure health care use and quality to compare the performance of 993 general internists and 971 family physicians with 284 hospitalists. The researchers looked at length of hospital stay, cost, death rates, and readmission rates for adult patients admitted to 45 U.S. hospitals from September 2002 to June 2005 with 7 conditions, including pneumonia, heart failure, and stroke.

Patients seen by hospitalists were likely to have shorter stays (2.9 days) compared with patients of general internists and family physicians (3.3 days). Costs remained in the same ballpark for all three (hospitalists: $5,129, internists: $5,397, and family physicians: $5,254), as did death rates and 14-day readmission rates. This study contradicts earlier findings that suggest employing hospitalists equals cost savings.

Although stay length was 10 percent shorter when hospitalists were in charge, these doctors may have been able to squeeze in more tests and treatments, as reflected in care costs, which were similar to the costs for internists and family physicians as the lead, the authors suggest. This study was funded in part by the Agency for Healthcare Research and Quality (HS11416).

See "Outcomes of care by hospitalists, general internists, and family physicians," by Peter K. Lindenauer, M.D., Michael B. Rothberg, M.D., M.P.H., Penelope S. Pekow, Ph.D., and others in the December 20, 2007, New England Journal of Medicine 357(25), pp. 2589-2600.

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