Primary care family physicians and 2 hospitalist models: comparison of outcomes, processes, and costs.
OBJECTIVE
To compare the care provided by family practice primary care physicians with that provided by 2 hospitalist models: critical care hospitalists and rotating residency faculty family physician hospitalists.


METHODS
Retrospective chart review. A health maintenance organization mandated that all patients be admitted to a critical care hospitalist team. The family physician hospitalists admitted all other residency patients and patients of some community family physicians. The primary care physicians admitted all their other patients. We adjusted for disease severity by using the Pneumonia Severity Index, age, sex, and comorbidities.


METHODS
Adults admitted with pneumonia to our private urban community hospital. Exclusions included patients with nosocomial pneumonia, human immunodeficiency virus, and acquired immunodeficiency syndrome.


METHODS
Primary (adjusted for age, sex, comorbidities, and disease severity): hospital charges, length of stay, in-hospital mortality, readmissions, and returns to the emergency room. Secondary: chest radiographs, intensive care use, blood and sputum cultures, compliance with American Thoracic Society guidelines, lifestyle and end-of-life counseling.


RESULTS
Of 97 patients, 21 were admitted to the critical care hospitalists, 53 to the family physician hospitalists, and 23 to primary care physicians. The mean charge ($5680) by the primary care physicians was significantly lower than that of the critical care hospitalists ($10,231; P=.005) and trended toward being lower than that of the family physician hospitalists ($7699; P=.08). The patients of critical care and family physician hospitalists had longer mean lengths of stay (critical care hospitalists, 3.8 days; family physician hospitalists, 3.9 days) than did those of the primary care physicians (2.6 days; P=.04 and.01, respectively). Compared with the primary care physicians, the critical care hospitalists were more likely to obtain at least 2 chest x-rays (odds ratio, 4.1; 95% confidence interval, 1.1-15.5) and trended toward increased odds of lengthy stay in the intensive care unit (odd ratio, 2.9; 95% confidence interval, 0.6-14.6). We found no other significant differences in primary or secondary outcomes.


CONCLUSIONS
Claims of better and cheaper care by hospitalists need further investigation. Meanwhile, the use of hospitalists should not be mandated, and the use of family physicians as hospitalists should be considered a good alternative to the use of subspecialists.
Smith
Peter C
PC
University of Colorado Health Sciences Center, Aurora 80045-0508, USA. peter.smith@uchsc.edu
Westfall
John M
JM
Nichols
Richard A
RA
D000368:Aged; D003120:Colorado; D003376:Counseling; D005180:Faculty, Medical; D005194:Family Practice / Q000191:economics / Q000592:standards*; D005260:Female; D017722:Hospital Charges; D020445:Hospitalists / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D015272:Pulmonary Medicine / Q000191:economics / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies