Abstract
OBJECTIVE
The objective of the present study was to compare the practice patterns of hospitalists and community physicians in the care of patients with congestive heart failure.
DESIGN/PARTICIPANTS/SETTING
The study was a retrospective chart review of 342 patients treated for congestive heart failure at a communityβbased teaching hospital.
MEASUREMENTS
Use of established therapeutic modalities for congestive heart failure and utilization of resources by hospitalists and nonhospitalists were compared. Outcome measures were adjusted length of stay (LOS), costs per case, inβhospital mortality, acute renal failure rate, and readmission rate.
RESULTS
The patients of hospitalist were more likely to receive ACEβI or ARB therapy within 24 hours of admission (86% vs. 72%; P = .003), intravenous diuretics (90% vs. 73%; P < .001), and social work consultation (48% vs. 29%; P < .001). They were less likely to have had serial chest radiographs (4% vs. 13%; P = .01) and multiple consultants (8% vs. 16%; P = .03). Hospitalists' patients with an illness whose severity was categorized as minor had a 40% reduction in LOS, those with a moderately severe illness had a 20% reduction, and those with an extremely severe illness had a 13% reduction (P = .002). Costs per case were reduced by $1000β$3100 across all severity categories (P < .001). Rates of acute renal failure and readmission were similar between the groups.
CONCLUSIONS
Early use of ACEβI/ARB, aggressive approach to diuresis, greater involvement of social work services and decreased use of chest radiographs and medical consultants were identified as distinct practices of hospitalists in this medical center. These practices may have led to a shorter LOS and lower costs while preserving quality of care and possibly improving clinical outcomes. Journal of Hospital Medicine 2008;3:35β41. Β© 2008 Society of Hospital Medicine.