(Reuters Health) – Many outcomes for hospital patients – including how long they stay and their survival odds after they go home – may depend on whether they’re cared for by their primary care physician or another type of doctor, a U.S. study suggests.
Researchers examined data on 560,651 admissions nationwide for patients covered by Medicare, the U.S. health program for the elderly and disabled, who had a variety of common medical problems. Their hospital care was overseen by one of three types of general medicine doctors: their primary care physician, a so-called hospitalist with special training in caring for hospitalized patients, or other generalists.
Compared to patients seen by hospitalists, patients seen by their primary care physicians had more specialist consultations and longer hospital stays, which can sometimes indicate less efficient care. But these patients were also more likely to be discharged home instead of a rehab or nursing facility, and they were also less likely to die within 30 days of leaving the hospital.
“It’s possible that primary care physicians aren’t willing to discharge until they feel like there’s a more ideal plan for home, and that hospitalists are discharging earlier, when people are medically stable, with the assumption that outpatient providers will work on further refining the care plan,” said lead study author Dr. Jennifer Stevens of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.
The difference in survival outcomes is harder to explain, Stevens said by email.
“We don’t know whether it’s because of something that happens in the hospital as a result of the primary care physician’s decisions, or because of how a primary care physician’s presence in the hospital influences post-hospital care,” Stevens added.
Hospitalists now outnumber any other specialty in internal medicine and they care for approximately three in every four patients in U.S. hospitals, researchers note in JAMA Internal Medicine.
The hospitalist model of care has taken hold in recent years as a way to shepherd increasingly complex patients with multiple serious and chronic health problems through hospital stays. Because they know how things work inside the hospital, they can expedite tests, coordinate specialist consultations, and work to improve both the efficiency and quality of care.
For the current study, researchers wanted to see if patient outcomes were different with hospitalists…