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【文摘发布】住院医师、普通内科医师、家庭医
Peter K. Lindenauer, M.D., Michael B. Rothberg, M.D., M.P.H., Penelope S. Pekow, Ph.D., Christopher Kenwood, B.S., Evan M. Benjamin, M.D., and Andrew D. Auerbach, M.D., M.P.H.
ABSTRACT
Background The hospitalist model is rapidly altering the landscape for inpatient care in the United States, yet evidence about the clinical and economic outcomes of care by hospitalists is derived from a small number of single-hospital studies examining the practices of a few physicians.
Methods We conducted a retrospective cohort study of 76,926 patients 18 years of age or older who were hospitalized between September 2002 and June 2005 for pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of chronic obstructive pulmonary disease, or acute myocardial infarction at 45 hospitals throughout the United States. We used multivariable models to compare the outcomes of care by 284 hospitalists, 993 general internists, and 971 family physicians.
Results As compared with patients cared for by general internists, patients cared for by hospitalists had a modestly shorter hospital stay (adjusted difference, 0.4 day; P<0.001) and lower costs (adjusted difference, $268; P=0.02) but a similar inpatient rate of death (odds ratio, 0.95; 95% confidence interval [CI], 0.85 to 1.05) and 14-day readmission rate (odds ratio, 0.98; 95% CI, 0.91 to 1.05). As compared with patients cared for by family physicians, patients cared for by hospitalists had a shorter length of stay (adjusted difference, 0.4 day; P<0.001), and the costs (adjusted difference, $125; P=0.33), rate of death (odds ratio, 0.95; 95% CI, 0.83 to 1.07), and 14-day readmission rate (odds ratio, 0.95; 95% CI, 0.87 to 1.04) were similar.
Conclusions For common inpatient diagnoses, the hospitalist model is associated with a small reduction in the length of stay without an adverse effect on rates of death or readmission. Hospitalist care appears to be modestly less expensive than that provided by general internists, but it offers no significant savings as compared with the care provided by family physicians.
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Outcomes of Care by Hospitalists, General Internists, and Family Physicians
住院医师、普通内科医师和家庭医师的治疗效果
Background The hospitalist model is rapidly altering the landscape for inpatient care in the United States, yet evidence about the clinical and economic outcomes of care by hospitalists is derived from a small number of single-hospital studies examining the practices of a few physicians.
背景：住院医师模式迅速的改变了美国住院病人治疗的景况，尽管关于住院医师治疗的临床和经济效果方面的证据仅仅来自于少数针对少量医生临床实践的单医院研究。
Methods We conducted a retrospective cohort study of 76,926 patients 18 years of age or older who were hospitalized between September 2002 and June 2005 for pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of chronic obstructive pulmonary disease, or acute myocardial infarction at 45 hospitals throughout the United States. We used multivariable models to compare the outcomes of care by 284 hospitalists, 993 general internists, and 971 family physicians.
方法：我们针对76926名18岁及以上的患者进行了一项回顾性研究，这些患者在2002年9月至2005年6月间因心力衰竭、胸痛、缺血性卒中、尿路感染、慢性阻塞性肺疾病急性加重及急性心肌梗死在美国的45家医院住院。
Results As compared with patients cared for by general internists, patients cared for by hospitalists had a modestly shorter hospital stay (adjusted difference, 0.4 day; P<0.001) and lower costs (adjusted difference, $268; P=0.02) but a similar inpatient rate of death (odds ratio, 0.95; 95% confidence interval [CI], 0.85 to 1.05) and 14-day readmission rate (odds ratio, 0.98; 95% CI, 0.91 to 1.05). As compared with patients cared for by family physicians, patients cared for by hospitalists had a shorter length of stay (adjusted difference, 0.4 day; P<0.001), and the costs (adjusted difference, $125; P=0.33), rate of death (odds ratio, 0.95; 95% CI, 0.83 to 1.07), and 14-day readmission rate (odds ratio, 0.95; 95% CI, 0.87 to 1.04) were similar.
结果：与普通内科医生治疗的病人相比，住院医生治疗的病人住院时间较短（校正后差值0.4天，P<0.001），费用较低（校正后差值268美元，P＝0.02），但住院死亡率（优势比0.95；95％可信区间0.85～1.05）和14天再住院率（优势比0.98；95％可信区间0.91～1.05）相似。与家庭医生治疗的病人相比，住院医师治疗的病人住院时间较短（校正后差值0.4天，P<0.001），而住院费用（校正后差值125美元，P＝0.33）、死亡率（优势比0.95；95％可信区间0.83～1.07）和14天再入院率（优势比0.95；95％可信区间0.87～1.04）相似。
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作者:admin@医学,生命科学 2011-02-15 05:11
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