Use of hospitalists fails to boost heart failure outcomes

The use of hospitalist physicians may not improve 30-day outcomes for patients hospitalized with heart failure, according to a study published online Sept. 11 in Journal of the American College of Cardiology: Heart Failure. Researchers found that care by hospitalists was not associated with lower 30-day readmission rates. Hospitalist use was, however, associated with a modest decrease in length of stay.

The use of hospitalists has increased across the U.S. in an effort to provide care that requires shorter hospital stays and lower costs, explained the authors, led by Robb D. Kociol, MD, associate director of advanced heart failure at Beth Israel Deaconess Medical Center in Boston.

“We wanted to see if the increased use of hospitalist care is associated with any improvements in any of the quality and economic metrics hospitals are concerned with, such as 30-day readmission rates, 30-day mortality and length of stay,” Kociol told Cardiovascular Business.

The researchers utilized data from the Get With the Guidelines-Heart Failure registry, a hospital-based quality improvement program that gathers data on heart failure hospitalizations. They included discharge dates between January 2005 and November 2008. All data were linked to Medicare claims for those years. They calculated the percentage of heart failure hospitalizations for each hospital that involved a hospitalist as an attending. There were a total of 31,505 Medicare beneficiaries in 166 hospitals. The use of hospitalists varied from 0 percent to 83 percent across the 166 hospitals.

“The results were a little murkier than we thought,” Kociol said. “We found, consistent with other studies, that hospitalist care seemed to be associated with a modest decrease in length of stay [0.09 days]. That probably corresponds to the fact that hospitalists’ incentives are aligned with those of the hospital.”

There was no significant association between hospitalist use and 30-day readmissions.

“We also found a very modest increased risk of mortality with increasing use of hospitalists, but the effect size was too small to tell whether or not it’s clinically meaningful,” Kociol explained.

The researchers also found that hospitalist use was not associated with significant improvements in the use of heart failure quality of care measures, but adding cardiologists to the mix, however, improved adherence.

The study findings, Kociol added, suggest that care involving both hospitalists and cardiologists may improve outcomes in patients with heart failure, but this hypothesis needs further study.

“One message is that moving over to a strictly hospitalist model of care for all heart failure patients probably isn’t the silver bullet to improve readmission rates,” he concluded.