PCPs Deliver Best Inpatient Care, Study Suggests

Previous studies indicating hospitalists give more efficient and safer care faced significant limitations, according to researchers.  

Amid the steady rise of the hospitalist model, inpatients cared for by their own primary care physicians experience lower length of stay and reduced mortality compared to hospitalists and covering generalists, according to a study published by JAMA Internal Medicine.

These findings appear to contradict previous research suggesting that hospitalists delivered more efficient and higher quality care, which authors of the new study allege faced substantial limitations. Previous studies, for example, did not differentiate among nonhospitalist physicians based on prior knowledge of the patient.

The study compared patient outcomes among three types of inpatient care delivery:

• PCPs with existing relationships with the patients
• Hospitalists with extensive knowledge of the hospital
• Generalists without previous familiarity with the patients or the hospital

"Our study is the first to distinguish between these two different types of outpatient physicians compared with hospitalists," wrote Jennifer P. Stevens, MD, MS, from Beth Israel Deaconess Medical Center in Boston, and colleagues in their report. 

Related: Researcher Disputes Link Between Lower Readmissions, Higher Mortality

For the study, researchers conducted a cohort study of 560,651 admissions of Medicare beneficiaries in 2013, controlled for patient factors and clinical features of the admissions, and made the following observations:

• PCPs used specialty consultation at a slightly higher rate than hospitalists, while other generalists consulted with specialists 6% more often than hospitalists.
• PCPs were more likely to discharge patients home (68.5%) compared with hospitalists (64%) and other generalists (62.1%).
• Median length of stay in the hospital was slightly longer for patients treated by PCPs compared with hospitalists and other generalists.
• Patients cared for by PCPs had lower 30-day mortality (8.6%) than patients of hospitalists (10.8%), while the mortality rate of patients of other generalists was higher (11%). 

"Our results suggest that longitudinal contact with a patient may translate into meaningful differences in care patterns and patient outcomes," the authors concluded. "Novel models of care that integrate PCPs who care for patients in the ambulatory setting with their patients’ hospital care may yield substantial benefits in outcomes that are meaningful to patients."