Do hospitalists affect clinical outcomes and efficiency for patients with acute upper gastrointestinal hemorrhage (UGIH)?
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.
The Center for Research in the Implementation of Innovative Strategies in Practice at the Iowa City Veterans Affairs Medical Center, Iowa City, Iowa 52246, USA.
Jorge T
JT
Go
Mary
M
Vaughan-Sarrazin
Andrew
A
Auerbach
Jeffrey
J
Schnipper
Tosha B
TB
Wetterneck
David
D
Gonzalez
David
D
Meltzer
Peter J
PJ
Kaboli
D001803:Blood Transfusion; D003365:Costs and Cost Analysis; D005260:Female; D005762:Gastroenterology / Q000191:economics / Q000379:methods* / Q000592:standards; D006471:Gastrointestinal Hemorrhage / Q000191:economics / Q000628:therapy*; D020445:Hospitalists; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States