Do hospitalists improve hospital care?

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Hospitalists are part of a relatively new medical specialty focused on caring for patients while they are being treated in a hospital. Working with a patient’s regular internist, cardiologist or oncologist, these physicians make sure needed tests are given and treatment guidelines are followed. You can think of them as the inpatient equivalent of an emergency room doctor. An estimated 20,000 hospitalists now work in 29% of the nation’s hospitals, and those numbers are growing fast.

But do they improve patient care? That question has been difficult to answer.

Two hospitalists and their colleagues at institutions affiliated with Harvard Medical School offer new evidence today that the answer is yes. Writing in the Archives of Internal Medicine, they find hospitals that employ hospitalists provide better care to patients with acute myocardial infarction and pneumonia than hospitals that don’t.

The researchers looked at data from 3,619 general medical and surgical hospitals that are part of the Hospital Quality Alliance. Of those facilities, 40% have hospitalists, and were more likely to be private, nonprofit teaching centers in big cities with at least 200 beds and a intensive care unit.

The study found that 93% of hospitals with hospitalists provided high-quality care to patients with acute myocardial infarction, or heart attacks, compared with 86% of hospitals without the specialists. For pneumonia, the scores were 75% versus 71%. After adjusting for several factors, the researchers concluded that care was 21% better for heart attacks and 11% better for pneumonia when hospitalists were involved. There was no statistically significant difference in outcomes for patients with congestive heart failure, according to the study.

Do hospitalists really deserve the credit for boosting those scores? The data show a correlation between their use and the quality of patient care, but that’s not the same as cause and effect. What’s more, the study shows that hospitals with higher ratios of registered nurses to patients “were consistently associated with better care.” Perhaps hospitals with more RNs were also more likely to employ hospitalists.

An editorial accompanying the study was also skeptical about its findings, calling them “not persuasive.” For instance, if hospitalists indeed made a difference in treatment of heart attacks, the researchers would need to explain how these doctors influenced the treatment prescribed by each patient’s cardiologist. Perhaps the hospitalists were able to make sure the cardiologists’ orders were carried out. If so, more research is needed to show that link.

-- Karen Kaplan