Study indicates why hospitalists improve hospital efficiency

August 13, 2004

You may not be familiar with the term but you might find yourself being treated by a "hospitalist" -- a physician who devotes all or most of his or her clinical time to the care of certain hospitalized patients. Previous studies have shown that hospitalist services improve efficiency of care by reducing hospital costs and length of stay, without compromising quality or patient satisfaction.

Now, researchers at the Department of Veterans Affairs (VA) Iowa City Health Care System and the University of Iowa have identified some factors associated with these efficiencies. The study results appear in the August issue of The American Journal of Managed Care.

Hospitalists, usually physicians in general internal medicine, serve as attending physicians for patients who are directed to inpatient care by their primary care provider or the emergency department. These patients are not sick enough to require treatment in an intensive care unit but have urgent, non-scheduled care needs for conditions such as pneumonia, liver disease, heart failure or diabetes complications.

The team analyzed 1,706 patient admissions in 2000-2001 to the four general internal medicine services at UI Hospitals and Clinics. One service was staffed solely by hospitalists and the three other services by non-hospitalist physicians in internal medicine. The investigators found that patients cared for by the hospitalists had on average a one-day shorter length of stay (5.5 vs. 6.5 days) and a 10 percent reduction in hospital costs.

Hospitalization costs for hospitalist patients were an average of $917 less than costs for non-hospitalist patients. The researchers demonstrated that the greatest savings were in the cost of in-hospital nursing services, likely directly related to the shortened length of stay.

"In these times of limited financial resources, hospitalists are seen as a way to potentially improve the efficiency of inpatient care. This study is the first to separate out various cost categories in an attempt to identify where the greatest savings occur," said Peter Kaboli, M.D., researcher and staff physician at the VA Iowa City Health Care System and assistant professor of internal medicine at the UI Roy J. and Lucille A. Carver College of Medicine.

The patients who lived within 25 miles of the hospital had the greatest reduction in length of stay, as did patients who required post-discharge nursing services such as skilled care or home care.

"We believe hospitalists may become more efficient in arranging needed nursing services after discharge and are more comfortable sending patients home earlier if they live close to the hospital for appropriate follow-up care," said Kaboli, who is one of five hospitalists now at UI Hospitals and Clinics.

The researchers also found a significant reduction in laboratory testing costs, but no reduction in the costs associated with radiology tests or pharmacy services. Although the overall hospitalization costs for hospitalist-treated patients was less than for the other patients, the average cost per day was $122 higher.

"Interestingly, the cost per day was higher for the hospitalist patients, suggesting that hospitalists were more efficient in performing the necessary evaluation and treatment of patients in the hospital to allow them to be discharged earlier," Kaboli said.

The team's analysis of readmission rates revealed that the shorter stays did not mean hospitalist patients were being sent home before they were stable. As with non-hospitalist patients, the hospitalist patients were readmitted within 30 days only about 8 percent of the time.

Hospitalists also may also be involved in co-managing surgical patients, such as orthopedic hip replacement patients who have medical problems after surgery. Kaboli said the study has some limitations because it focuses on one academic medical center, although the findings have implications for both academic and community-based hospitals, health plans and patients. "As health plans are faced with rising costs, attention on efficiency is needed," he said.

David Meltzer, M.D., Ph.D., an associate professor of medicine at the University of Chicago Pritzker School of Medicine who is leading a multicenter study on hospitalists, agreed that it is important to study hospitalist programs in multiple sites because there are variables that need to be understood.

"One of the nice things for UI Health Care and the patients who are served by it is that the institution has gone to the trouble of doing a good evaluation. It is studies like this that, as they build together, let us understand what makes a hospitalist program successful," said Meltzer, who also has appointments in economics and public policy at UC.

Meltzer's study, which involves Kaboli and UI/VA colleagues, includes six academic medical centers and nearly 35,000 patients over the past three years.

In addition to Kaboli, the VA/UI study included Gary Rosenthal, M.D., staff physician and researcher with the VA Iowa City Health Care System and UI professor of internal medicine; and Mitch Barnett, VA Iowa City Health Care system. The UI hospitalist service is directed by Scott Wilson, D.O., UI associate professor (clinical) of internal medicine. Funding for the study included a VA Research Associate Award to Kaboli.
The journal article will be available online at

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at

STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178

CONTACT: Media: Becky Soglin (writer), 319-335-6660,

PHOTO: An electronic photo of Dr. Peter Kaboli is available online at

University of Iowa

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