Is your own MD best in the hospital? Study eyes hospitalists

November 13, 2017 by Lindsey Tanner
Is your own MD best in the hospital? Study eyes hospitalists
In this April 25, 2014, file photo, a sign points the way to a hospital in Georgia. A study shows that Medicare patients with common illnesses who were treated by their own familiar primary care doctors were slightly more likely to survive after being sent home than those treated by hospitalists, internists who don't provide care outside of hospitals. (AP Photo/David Goldman, File)

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 with common conditions including pneumonia, heart failure and urinary infections who were treated by their own primary care 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 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, 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.

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. These were physicians who likely didn't know the patients or the hospital well, Stevens said.

The average length of stay was about 5 days for or general care and about half a day shorter for hospitalists.

Those treated by other general physicians were slightly more likely than the others to die within 30 days of discharge and to be readmitted to the hospital.

Explore further: Patients more satisfied with care from hospitalists

Related Stories

Patients more satisfied with care from hospitalists

February 8, 2016
(HealthDay)—More patients report satisfaction with overall care in a nonteaching hospitalist service than in a general medicine teaching service, according to research published in the February issue of the Journal of Hospital ...

Major communication gaps between doctors and home health care nurses revealed

July 19, 2017
Researchers at the University of Colorado Anschutz Medical Campus have found serious gaps in communication between physicians and home health care agencies responsible for caring for often elderly patients discharged from ...

Expanding role of hospitalist PAs achieves similar clinical outcomes, costs less

October 24, 2016
More and more medical centers are relying on hospitalists—hospital-based internal medicine specialists who coordinate the complex care of inpatients. Now, an 18-month study comparing two hospitalist groups—one with a ...

Hospitals and physicians should improve communication for better patient care

March 25, 2015
Coordinating patient care between hospital clinicians and primary-care physicians is a significant challenge due to poor communication and gaps in information-sharing strategies, according to a study led by physicians at ...

Recommended for you

Tackling health problems in the young is crucial for their children's future

February 21, 2018
A child's growth and development is affected by the health and lifestyles of their parents before pregnancy - even going back to adolescence - according to a new study by researchers at the Murdoch Children's Research Institute, ...

Why teens need up to 10 hours' sleep

February 21, 2018
Technology, other distractions and staying up late make is difficult, but researchers say teenagers need to make time for 8-10 hours of sleep a night to optimise their performance and maintain good health and wellbeing.

Electronic health records don't reduce administrative costs

February 21, 2018
The federal government thought that adopting certified electronic health record systems (EHR) would reduce administrative costs for physicians in a variety of specialties. However, a major new study conducted by researchers ...

Low-fat or low-carb? It's a draw, study finds

February 20, 2018
New evidence from a study at the Stanford University School of Medicine might dismay those who have chosen sides in the low-fat versus low-carb diet debate.

Tobacco kills, no matter how it's smoked: study

February 20, 2018
(HealthDay)—Smokers who think cigars or pipes are somehow safer than cigarettes may want to think again, new research indicates.

Just a few minutes of light intensity exercise linked to lower death risk in older men

February 19, 2018
Clocking up just a few minutes at a time of any level of physical activity, including of light intensity, is linked to a lower risk of death in older men, suggests research published online in the British Journal of Sports ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.