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Assessing the Impact of Hospitalists

Peter K. Lindenauer, MD, MSc; Rona Chehabeddine, MPH; Penelope Pekow, PhD; Janice Fitzgerald, MS, RN; Evan M. Benjamin, MD

Arch Intern Med. 2002;162:1251-1256.

Background  The quality of care provided to patients hospitalized for heart failure has been shown to vary by physician, hospital, and region. Hospitalists appear to reduce costs and length of stay, yet their impact on quality of care is less certain.

Objective  To compare quality of care and resource utilization among patients with heart failure treated by hospitalists and nonhospitalist general internists.

Methods  We reviewed the medical records of patients with a principal diagnosis of heart failure between April 1, 1999, and March 30, 2000, at a 550-bed community-based teaching hospital in Massachusetts. We evaluated quality of care by measuring adherence to a set of commonly used process measures and compared resource utilization using severity-adjusted length of stay and costs.

Results  The analysis included 280 patients, accounting for 326 heart failure admissions: 20 hospitalists cared for 137 (42%) cases, while 65 nonhospitalists cared for 189 (58%). Of 137 hospitalist cases, 129 (94%) had new or prior left ventricular ejection fraction testing results documented during the hospitalization compared with 165 (87%) of 189 nonhospitalist cases (P = .04). In cohorts of ideal candidates, performance rates for hospitalist and nonhospitalist cases were similar for prescriptions of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for patients with ejection fractions lower than 40% (97% vs 96%; P>.99) and warfarin for patients with atrial fibrillation (60% vs 55%; P = .64). Rates of comprehensive discharge counseling was similar in the 2 groups. Multivariable modeling did not substantially alter these findings. After adjusting for differences in severity, patients treated by hospitalists had a shorter length of stay but similar overall costs when compared with those treated by nonhospitalists.

Conclusion  Compared with nonhospitalists, hospitalists were more likely to document assessment of left ventricular function and their patients had a shorter length of stay.

From the Division of Healthcare Quality, Baystate Medical Center, Springfield, Mass (Drs Lindenauer, Pekow, and Benjamin and Ms Fitzgerald), the Department of Epidemiology and Biostatistics, University of Massachusetts, Amherst (Ms Chehabeddine and Dr Pekow), and the Department of Medicine, Tufts University School of Medicine, Boston, Mass (Drs Lindenauer and Benjamin).

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