Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage?

1Iowa City VAMC and University of Iowa, Iowa City, IA
2Iowa City VAMC and University of Iowa, Iowa City, IA
3University of California, San Francisco, San Francisco, CA
4Brigham and Women's Hospital, Boston, MA
5University of Wisconsin, Madison, Wl
6University of New Mexico, Albuquerque, NM
7University of Chicago, Chicago, IL
8Iowa City VAMC and University of Iowa, Iowa City, IA

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 40

Background:

Care by hospitalists has, in general, been associated with improved or similar cfinical outcomes and improved efficiency. However, less is known about the affect of hospitalists on conditions that may be dependent on consultants for procedures and/or treatment plans. Our objective was to compare clinical outcomes and efficiency for patients with acute upper gastrointestinal hemorrhage (UGIH) cared for by hospitalists and nonhospitalists.

Methods:

Analyses included 450 patients with UGIH admitted to the general medical services of 6 teaching hospitals. Clinical outcomes included in‐hospital mortality and complications (i.e., rebleeding, ICU transfer, decompensation, transfusion, re‐endoscopy, 30‐day readmission). Efficiency was measured by hospital costs and length of stay (LOS). Severity of illness was captured by a validated risk score (Rockall) and comorbidty by the Charlson index. Multivariable linear regression models were created for LOS and costs adjusting for covariates. Data were obtained from administrative records and charts reviewed by trained abstractors.

Results:

Of the 450 patients, 40% (177) were cared for by hospitalists. Endoscopic diagnoses were similar in the 2 groups (P > 0.05), with peptic ulcer disease, erosive disease, and varices the most common. There was also no difference between groups by Rockall score or Charlson index. When comparing clinical outcomes between hospitalists and nonhospitalists, results were similar (P > 0.05) for mortality (2.3% vs. 0.4%), rebleeding (11% vs. 11%), ICU transfer (13% vs. 8.8%), and decompensation (15% vs. 15%), as well as an overall composite measure of any complication (79% vs. 72%). However, patients cared for by hospitalists were more likely to receive a transfusion (74% vs. 63%; P = 0.02) and be readmitted within 30 days (7.3% vs. 3.3%; P = 0.05). For efficiency, mean LOS was similar for hospitalists and nonhospitalists (4.8 vs. 4.5 days; P = 0.30). However, patients cared for by hospitalists had higher median costs ($7359 vs. 6181; P < 0.01). In multivariable analyses, LOS remained similar (4.9 vs. 4.6 days; P = 0.17), and costs were $1264 higher for hospitalists (P = 0.02).

Conclusions:

Despite having similar outcomes and LOS, costs were higher for UGIH patients attended by hospitalists compared with those treated by nonhospitaiists. These results suggest that the affect of hospitalists may be tempered for patients who require consultants for procedures or management. Understanding what patient groups receive the greatest potential benefit from hospitalist care will help guide both organizational efforts and quality improvement strategies.

Author Disclosure:

J. T. Go, none; Mary Vaughan‐Sarrazin, none; A. Auerbach, none; J. Schnipper, none; T. B. Wetterneck, none; D. Gonzalez, none; D. Meltzer, none; P. J. Kaboli, none.

To cite this abstract:

Go J, Vaughan‐Sarrazin M, Auerbach A, Schnipper J, Wetterneck T, Gonzalez D, Meltzer D, Kaboli P. Do Hospitalists Affect Clinical Outcomes and Efficiency for Patients with Acute Upper Gastrointestinal Hemorrhage?. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 40. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/do-hospitalists-affect-clinical-outcomes-and-efficiency-for-patients-with-acute-upper-gastrointestinal-hemorrhage/. Accessed July 16, 2019.

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