Chattanooga Times Free Press

Study suggests personal doctors best in hospitals

- BY LINDSEY TANNER

CHICAGO — The old-fashioned, family doctor style of medicine could be lifesaving for elderly hospitaliz­ed patients, a big study suggests, showing benefits over a rapidly expanding alternativ­e that has hospital-based doctors overseeing care instead.

Medicare patients with common conditions including pneumonia, heart failure and urinary infections who were treated by their own primary care doctors were slightly more likely to survive after being sent home than those cared for instead by hospitalis­ts — internists who provide care only in hospitals.

While hospitalis­t care can shorten stays and reduce costs, the new results suggest that, for at least some patients, getting taken care of in the hospital by a doctor who knows them can have important advantages.

Almost 11 percent of patients cared for by a hospitalis­t died within 30 days of leaving the hospital, compared with just under 9 percent of primary care patients. While that difference was small, it “was certainly a startling finding,” said Dr. Jennifer Stevens, the study’s lead author at Harvard Medical School.

Also, among hospitalis­t patients, 36 percent were sent to a nursing home or other longterm care center, versus about 30 percent of primary care patients. Studies show that elderly patients who are discharged to nursing homes are less likely than others to ever return to their homes, Stevens said.

Reasons for those advantages are unclear. Stevens noted that primary care doctors who know their patients’ health and family histories may be more attuned to how well they can manage at home after hospitaliz­ation and which potentiall­y risky follow-up tests or medicines they can avoid.

Stevens and her colleagues analyzed Medicare claims data on nearly 600,000 hospital admissions in 2013. Their results were published Monday in JAMA Internal Medicine.

The researcher­s don’t advocate replacing hospitalis­ts, but Stevens said the study “opens the door” to limiting their use with certain hospital patients, particular­ly the elderly. Patients in the study were aged 80 on average.

The hospitalis­t specialty has grown since the 1990s amid insurance industry changes, rising demands on primary care doctors’ time and research showing hospitalis­ts can shorten patients’ stays and reduce costs. In 1995, hospitalis­ts provided 9 percent of general medicine services in hospitals, but by 2013 that had grown to nearly 60 percent, a journal editorial noted.

Newspapers in English

Newspapers from United States