Do older internists use more hospital resources than younger internists for patients hospitalized with chest pain? A study of patients hospitalized in the coronary care and intermediate care units.
OBJECTIVE
Recent concern about escalating healthcare expenditures has prompted healthcare payers and hospitals to identify physicians whose hospital resource consumption exceeds expected norms. The goals of this study were to determine whether analyses of practice patterns in this manner may a) systematically identify older physicians as big resource "spenders," and b) provide misleading information caused by the failure to adjust utilization data for severity of illness.


METHODS
A prospective, observational study.


METHODS
The coronary care and intermediate care unit in an 1,100-bed community hospital.


METHODS
A total of 217 patients hospitalized for chest pain cared for by noncardiologists.


METHODS
None.


RESULTS
On initial inspection, it appeared that the patients of older physicians had longer lengths of stay and greater charge expenditures than the patients of younger physicians. However, further evaluation demonstrated that older physicians cared for older (76 vs. 67 yrs old, p = .0001) and more severely ill patients (judged by risk of complications, risk of acute ischemic heart disease, and disease staging). Older physicians cared for more severely ill myocardial infarction patients than did younger physicians (Killip Classification 2.0 vs. 1.1, p less than .00003). After adjusting for severity of illness, there were fewer differences in hospital charges and consultant use between older and younger physicians, although the patients of older physicians remained hospitalized longer.


CONCLUSIONS
There is little difference in resource utilization between patients cared for by older and younger internists after controlling for severity of illness. This investigation highlights the potential hazards of ignoring severity of illness when judging physician efficiency in the coronary care unit.
Weingarten
S
S
Department of Medicine, Cedars-Sinai Medical Center, UCLA School of Medicine 90048.
Bolus
R
R
Riedinger
M
M
Selker
H
H
Ellrodt
A G
AG
D000367:Age Factors; D002637:Chest Pain / Q000453:epidemiology / Q000628:therapy*; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006746:Hospital Bed Capacity, 500 and over; D006760:Hospitalization / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007380:Intermediate Care Facilities / Q000706:statistics & numerical data*; D007388:Internal Medicine / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D010820:Physicians / Q000706:statistics & numerical data; D011446:Prospective Studies; D012720:Severity of Illness Index; D000078329:Workforce