Upper gastrointestinal hemorrhage (UGIH) patients attended by academic hospitalists and nonhospitalists exhibited similar outcomes and length of stay (LOS), but those cared for by the hospitalists required higher costs for care, according to a study published in this month's Journal of Hospital Medicine.
The report,"Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage (UGIH)?" (2010;5(3):132-138), says "median LOS was similar for hospitalists and non-hospitalists (4 days; P=0.69), but patients cared for by hospitalists had higher median costs ($7,359 vs. $6,181; P
"Our hypothesis going into it was that the presence of a hospitalist may impact the efficiency of the quality of care for this type of condition," says senior author Peter Kaboli, MD, MS, FHM, a hospitalist at the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the VA Medical Center in Iowa City, Iowa. "But we weren't sure, because this condition is so dependent on subspecialty care that our thought was possibly the need for subspecialists would attenuate that potential hospitalist effect we see in many other studies."
Dr. Kaboli and colleagues could not draw a specific conclusion for why the disparity of costs existed. He suggests that the higher intensity of costs in HM models is one contributing factor, as is the co-management model that eliminates a hospitalist's ability to unilaterally—and more quickly—make decisions that affect care and costs.
Regardless, Dr. Kaboli is hopeful the study spurs more research into why the cost variation exists and encourages HM leaders to review their UGIH care standards.
"Look at lengths of stay. Look at time to endoscopy," Dr. Kaboli says. "Look to see what you can do to improve that efficiency and improve that coordination of care. And, frankly, because so much of what we do is on a DRG-based payment system, we all do better and patients do better if we have highly efficient care."