Comparison of Hospitalization and Post-Hospitalization Outcomes among Family Medicine Hospitalists and Internal Medicine Hospitalists in a Tertiary Center: A Prospective Cohort Study
Family medicine versus internal medicine services’ outcomes
DOI:
https://doi.org/10.58877/japaj.v1i1.11Keywords:
Internal medicine, hospitalist, family medicine, length of stay, patient readmission, hospital costsAbstract
Background: There is a lack of studies comparing hospitalization and post-hospitalization outcomes between internal medicine (IM) hospitalists and family medicine (FM) hospitalists.
Objective: To compare the length of stay (LOS), hospital cost, and 30-day all-cause readmission rate among patients treated by IM hospitalists and FM hospitalists.
Design and Setting: Prospective cohort study in a referral center. Propensity score matching was used to balance baseline characteristics between comparative arms.
Participants: 747 patients 18 years and older who were admitted to hospitalist services.
Intervention: Treatment by IM hospitalists and FM hospitalists.
Main Measures: LOS, hospital cost, and 30-day all-cause readmission. Treatment arms were compared by two methods. We compared patients who were seen by FM exclusively with those treated exclusively by IM services. Covariate adjusted differences in outcomes were estimated by multivariable regression. For a secondary set of analyses, exposure to FM and IM was converted to a continuous independent variable.
Key Results: Forty, 333, and 374 patients were seen by FM, IM, and a combination of both services, respectively. Using average treatment on the treated as the estimand, FM care provided a shorter weight-adjusted LOS by 0.5 days (CI: -0.92- -0.04, P =0.026) compared to IM, but no difference in hospital cost (-126, CI: -906-653, P=.74). There was no difference in adjusted hazard for 30-day readmission between FM and IM (HR: 2, CI: 0.67-6.2, P =0.062). Propensity weight-adjusted multiple regression models of the complete cohort (n=747) did not show any difference in any outcomes with increased exposure to FM care.
Conclusions: Understanding variation in practices and outcomes between different hospitalist models opens opportunities to improve care and decrease the length of stay.
References
American Board of Physician Specialties. What is a Hospitalist? 2019 [Available from: https://www.abpsus.org/what-is-a-hospitalist.
American Association of Medical Colleges. Medical school graduation questionnaire: 2018 all schools summary report. 2018.
Wachter RM, Goldman L. Zero to 50,000 — The 20th Anniversary of the Hospitalist. New England Journal of Medicine. 2016;375(11):1009-11.
Wachter RM, Goldman L. The hospitalist movement 5 years later. Jama. 2002;287(4):487-94.
Pinzur MS, Gurza E, Kristopaitis T, Monson R, Wall MJ, Porter A, et al. Hospitalist-orthopedic co-management of high-risk patients undergoing lower extremity reconstruction surgery. Orthopedics. 2009;32(7):495.
Gunderman R. Hospitalists and the Decline of Comprehensive Care. New England Journal of Medicine. 2016;375(11):1011-3.
Ireland J. ABFM and ABIM to jointly participate in recognition of focused practice (rfp) in hospital medicine pilot approved by abms. Ann Fam Med. 2010;8(1):87-.
Weaver SP, Hill J. Academician Attitudes and Beliefs Regarding the Use of Hospitalists: A CERA Study. Fam Med. 2015;47(5):357-61.
Baldor R, Savageau JA, Shokar N, Potts S, Gravel J, Jr., Eisenstock K, et al. Hospitalist involvement in family medicine residency training: A CERA study. Fam Med. 2014;46(2):88-93.
Jones K, Whatley M. Hospitalists: a growing part of the primary care workforce. AAMC Analysis in Brief. 2016;16(5).
Lindenauer PK, Rothberg MB, Pekow PS, Kenwood C, Benjamin EM, Auerbach AD. Outcomes of care by hospitalists, general internists, and family physicians. The New England journal of medicine. 2007;357(25):2589-600.
Tingle LE, Lambert CT. Comparison of a family practice teaching service and a hospitalist model: costs, charges, length of stay, and mortality. Fam Med. 2001;33(7):511-5.
Smith PC, Westfall JM, Nichols RA. Primary care family physicians and 2 hospitalist models: comparison of outcomes, processes, and costs. J Fam Pract. 2002;51(12):1021-7.
Mustafa Ali MK, Sabha MM, Mustafa SK, Banifadel M, Ghazaleh S, Aburayyan KM, et al. Hospitalization and Post-hospitalization Outcomes Among Teaching Internal Medicine, Employed Hospitalist, and Locum Tenens Hospitalist Services in a Tertiary Center: a Prospective Cohort Study. J Gen Intern Med. 2021;36(10):3040-51.
Office for Human Research Protections. 45 Code of Federal Regulations 46 2018 [Available from: https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=83cd09e1c0f5c6937cd9d7513160fc3f&pitd=20180719&n=pt45.1.46&r=PART&ty=HTML.
Organizations on the Care Everywhere Network [Available from: https://www.epic.com/careeverywhere/.
Ohio Department of Health. Active hospitals in Lucas county: Ohio Department of Health; [Available from: http://publicapps.odh.ohio.gov/eid/Search_Results.aspx.
Ho DE, Imai K, King G, Stuart EA. Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference. Political analysis. 2007;15(3):199-236.
Austin PC. Variance estimation when using inverse probability of treatment weighting (IPTW) with survival analysis. Statistics in medicine. 2016;35(30):5642-55.
R Development Core Team R. R: A language and environment for statistical computing. R foundation for statistical computing Vienna, Austria; 2020.
Wachter RM, Goldman L. The Emerging Role of “Hospitalists” in the American Health Care System. New England Journal of Medicine. 1996;335(7):514-7.
Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in internal medicine. 2019.
Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in family medicine. 2019.
American College of Physicians. Internal Medicine vs. Family Medicine [Available from: https://www.acponline.org/about-acp/about-internal-medicine/career-paths/medical-student-career-path/internal-medicine-vs-family-medicine.
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