Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage (UGIH)?

Jorge T Go; Mary Vaughan-Sarrazin; Andrew Auerbach; Jeffrey Schnipper; Tosha B Wetterneck; David Gonzalez; David Meltzer; Peter J Kaboli

doi:10.1002/jhm.612

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Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage (UGIH)?

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Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage (UGIH)?

Jorge T Go, Mary Vaughan-Sarrazin, Andrew Auerbach, Jeffrey Schnipper, Tosha B Wetterneck, David Gonzalez, David Meltzer and Peter J Kaboli

Journal of hospital medicine, Vol.5(3), pp.133-139

03/2010

DOI: 10.1002/jhm.612

PMCID: PMC3587174

PMID: 20235292

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https://www.ncbi.nlm.nih.gov/pmc/articles/3587174View

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Abstract

Background: Care by hospitalists has been associated with improved/similar clinical outcomes and efficiency. However, less is known about their effect on conditions dependent upon specialists for procedures/treatment plans. Our objective was to compare care for upper gastrointestinal hemorrhage (UGIH) patients attended by academic hospitalists and nonhospitalists. Methods: The study included 450 UGIH patients admitted to general medical services of 6 teaching hospitals. Outcomes included in-hospital mortality and complications (ie, recurrent bleeding, intensive care unit [ICU] transfer, decompensation, transfusion, reendoscopy, 30-day readmission). Efficiency was measured by hospital costs and length of stay (LOS). Results: Of 450 patients, 40% (177) were cared for by hospitalists with no differences between groups by endoscopic diagnosis, performance of early esophagogastroduodenoscopy (EGD), Rockall risk score, or Charlson comorbidity index. Unadjusted clinical outcomes between hospitalists and nonhospitalists were similar except for 2 outcomes: patients cared for by hospitalists were more likely to receive a transfusion (74% vs. 63%; P = 0.02) or be readmitted within 30 days (7.3% vs. 3.3%; P = 0.05). However, differences in adverse outcomes between providers were not seen after multivariable adjustments. Median LOS was similar for hospitalists and nonhospitalists (4 days; P = 0.69), but patients cared for by hospitalists had higher median costs ($7,359 vs. $6,181; P < 0.01). In multivariable analyses, LOS was similar (5.2 vs. 4.7 days; P = 0.15) and costs remained higher for the hospitalist-led teams (P < 0.03). Conclusions: Despite having similar overall outcomes and LOS, costs were higher in UGIH patients attended by hospitalists. These results suggest that the academic hospitalist model may be tempered in patients requiring specialists for procedures or management.

length of stay

costs

hospitalists

outcomes

Gastrointestinal hemorrhage

Details

Title: Subtitle: Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage (UGIH)?
Creators: Jorge T Go - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center, Iowa City, IA and the Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine
Mary Vaughan-Sarrazin - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center, Iowa City, IA and the Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine
Andrew Auerbach - Department of Medicine, University of California, San Francisco, San Francisco, CA
Jeffrey Schnipper - Brigham and Women’s/Faulkner Hospitalist Program, Division of General Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
Tosha B Wetterneck - Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
David Gonzalez - Department of Medicine, University of of New Mexico, Albuquerque, NM
David Meltzer - Departments of Medicine, Economics, and Public Policy, University of Chicago, Chicago, IL
Peter J Kaboli - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center, Iowa City, IA and the Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine
Resource Type: Journal article
Publication Details: Journal of hospital medicine, Vol.5(3), pp.133-139
DOI: 10.1002/jhm.612
PMID: 20235292
PMCID: PMC3587174
NLM abbreviation: J Hosp Med
ISSN: 1553-5592
eISSN: 1553-5606
Grant note: R21 AG028122 || AG / National Institute on Aging : NIA
Language: English
Date published: 03/2010
Academic Unit: Health Management and Policy; Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984063200902771

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