Is your M.D. best in the clinic? Study eyes hos­pi­tal­ist treat­ment

The Washington Times Daily - - NATION - 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 long-term 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, Dr. Stevens said.

Rea­sons for those ad­van­tages are un­clear. Dr. 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.

Dr. 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 Dr. 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.

Hos­pi­tal­ists may bring “new eyes” to pa­tients’ prob­lems, but the study re­sults, if valid, sug­gest there’s a trade­off, the ed­i­to­rial said.

In the study, 60 per­cent of pa­tients got their hospi­tal care from hos­pi­tal­ists ver­sus only 14 per­cent from their pri­mary care doc­tors. The rest got care from other gen­eral physi­cians in­clud­ing part­ners of pa­tients’ pri­mary physi­cians.


A new study found 11 per­cent of pa­tients who were cared for in in­sti­tu­tional set­tings died within 30 days, com­pared to just un­der 9 per­cent of pri­mary care pa­tients.

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