JAMA Internal Medicine has published a study titled “Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists.” The investigators studied how the type of physician providing care to hospitalized patients affected the care and outcomes of patients both in hospital and after discharge.  They studied 560,651 Medicare beneficiaries admitted to the hospital for 20 common medical conditions in 2013 and compared care delivered by hospitalists to two groups of primary outpatient physicians, those who were the patients’ primary care physicians and other physicians who were not the patients’ PCP.

The majority of patients (60%), were cared for by hospitalists, 14% were cared for by their primary care physician, and 26% by other generalists. Past work has shown that the hospitalist model is popular because they may be more familiar with and use hospital resources more efficiently.

The investigators found that patients cared for by their own primary care physician while in hospital had similar lengths of stay and number of inpatient consults when compared to hospitalists, but they were more likely to be discharged directly to home instead of a nursing home.  They also had improved survival in the 30 days after discharge (9% versus 11% after adjustment).  Those cared for by other outpatient physicians had similar mortality rates to hospitalists, but had longer lengths of stay, more use of specialty consults while in the hospital, and higher rates of readmissions at 7 and 30 days.

These results suggest a trade-off between primary care physician’s familiarity with patients and hospitalist’s knowledge of hospital medicine.

This study was spearheaded by Jennifer P Stevens, MD, with co-authors health care policy associate professor Laura Hatfield, PhD, health care policy professor Bruce Landon, MD, MBA, MSc,  David J. Nyweide, PhD, Sha Maresh, DrPH of the CMS Innovation Center, and Michael D. Howell, MD, MPH, of the University of Chicago (now at google).

To read the full study, visit the JAMA Internal Medicine website.

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