(Reuters Health)—Many outcomes for hospital patients—including how long they stay and their survival odds after they go home—may depend on whether or not they’re cared for by their primary care physician, a U.S. study suggests.
Researchers examined data on 560,651 admissions nationwide for patients covered by Medicare, the U.S. health program for the elderly and disabled, who had a variety of common medical problems. Their hospital care was overseen by either their primary care physician, a hospitalist, or another generalist.
Compared with patients seen by hospitalists, patients seen by their primary care physicians had more specialist consultations and longer hospital stays. But these patients were also more likely to be discharged home instead of a rehab or nursing facility, and they were also less likely to die within 30 days of leaving the hospital.
“It’s possible that primary care physicians aren’t willing to discharge until they feel like there’s a more ideal plan for home, and that hospitalists are discharging earlier, when people are medically stable, with the assumption that outpatient providers will work on further refining the care plan,” says lead study author Dr. Jennifer Stevens of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.
The difference in survival outcomes is harder to explain, Stevens says by email.
“We don’t know whether it’s because of something that happens in the hospital as a result of the primary care physician’s decisions, or because of how a primary care physician’s presence in the hospital influences post-hospital care,” Stevens adds.
Hospitalists now outnumber any other specialty in internal medicine and they care for approximately three in every four patients in U.S. hospitals, researchers noted online Nov. 13 in JAMA Internal Medicine.1
For the current study, researchers wanted to see if patient outcomes were different with hospitalists than with a primary care physician or another general medicine physician.
Hospitalists cared for 60% of patients in the study, while primary care physicians saw 14% of the patients and other generalists treated 26% of the patients.
Compared with hospitalists, primary care physicians used consultations 3% more often and other generalists used consultations 6% more often, the study found.
Hospital stays were also 12% longer with primary care physicians and 6% longer with other generalists than with hospitalists.
Primary care physicians were 14% more likely than hospitalists to discharge patients to home instead of institutional care settings, while generalists were 6% less likely than hospitalists to do this.
Readmissions within one week or one month of discharge were similar for primary care physicians and hospitalists but more frequent with other generalists.
Patients cared for by primary care physicians were 6% less likely to die within 30 days of discharge than people treated by hospitalists. But with generalists, patients were 9% more likely to die than with primary care physicians.
The study wasn’t a controlled experiment designed to prove whether or how the type of doctor treating hospital patients influences outcomes.
“This does not show that the hospitalist model does not work,” says Dr. Seth Landefeld, author of an accompanying editorial and a researcher at the University of Alabama at Birmingham.
But it does suggest there are benefits to sticking with one doctor.
“A trusting relationship with a doctor who will `orchestrate’ your care through the course of illness can be very valuable, rather than bouncing from one subspecialist to another without a `conducting’ doctor,” Landefeld says by email.
Reference
- Stevens JP, Nyweide DJ, Maresh S, et al. Comparison of hospital resource use and outcomes among hospitalists, primary care physicians and other generalists. JAMA Intern Med. 2017 Nov 13. doi: 10.1001/jamainternmed.2017.5824. [Epub ahead of print]
