Comparison of practice patterns of hospitalists and community physicians in the care of patients with congestive heart failure

Abstract

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. The study was a retrospective chart review of 342 patients treated for congestive heart failure at a community-based teaching hospital. 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, in-hospital mortality, acute renal failure rate, and readmission rate. The patients of hospitalist were more likely to receive ACE-I 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 $1000-$3100 across all severity categories (P < .001). Rates of acute renal failure and readmission were similar between the groups. Early use of ACE-I/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.