Tuesday, April 08, 2014

Hospitalists and heart failure outcomes

JACC Heart Failure has published data from a large heart failure registry:

Results The analysis included 31,505 Medicare beneficiaries in 166 hospitals. Across hospitals, the use of hospitalists varied from 0% to 83%. After multivariable adjustment, a 10% increase in the use of hospitalists was associated with a slight increase in mortality (risk ratio: 1.03; 95% confidence interval [CI]: 1.00 to 1.06) and decrease in length of stay (0.09 days; 95% CI: 0.02 to 0.16). There was no association with 30-day readmission. Increased use of hospitalists in hospitals with high use of cardiologists was associated with improved defect-free adherence to a composite of heart failure performance measures (risk ratio: 1.03; 95% CI: 1.01 to 1.06).

Hospitalist care was associated with a slight reduction in LOS and a slight increase in mortality (borderline statistical significance) despite higher adherence to performance measures. The findings are not surprising. Hospitalists are doing what they are incented to do: get patients out faster and score better on various metrics. The benefit to patients is dubious.

Via Hospital Medicine Virtual Journal Club.

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