Evaluating the Outcome of Multi-Morbid Patients Cared for by Hospitalists: a Report of Integrated Medical Model in Korea

Abstract

Background The lack of medical personnel has led to the employment of hospitalists in Korean hospitals to provide high-quality medical care. However, whether hospitalists' care can improve patients' outcomes remains unclear. We aimed to analyze the outcome in patients cared for by hospitalists. Methods A retrospective review was conducted in 1,015 patients diagnosed with pneumonia or urinary tract infection from March 2017 to July 2018. After excluding 306 patients, 709 in the general ward who were admitted via the emergency department were enrolled, including 169 and 540 who were cared for by hospitalists (HGs) and non-hospitalists (NHGs), respectively. We compared the length of hospital stay (LOS), in-hospital mortality, readmission rate, comorbidity, and disease severity between the two groups. Comorbidities were analyzed using Charlson comorbidity index (CCI). Results HG LOS (median, interquartile range [IQR], 8 [5–12] days) was lower than NHG LOS (median [IQR], 10 [7–15] days), ( P < 0.001). Of the 30 (4.2%) patients who died during their hospital stay, a lower percentage of HG patients (2.4%) than that of NHG patients (4.8%) died, but the difference between the two groups was not significant ( P = 0.170). In a subgroup analysis, HG LOS was shorter than NHG LOS (median [IQR], 8 [5–12] vs. 10 [7–16] days, respectively, P < 0.001) with CCI of ≥ 5 points. Conclusion Hospitalist care can improve the LOS of patients, especially those with multiple comorbidities. Further studies are warranted to evaluate the impact of hospitalist care in Korea.

Impact of Hospitalist Care Model on Patient Outcomes in Acute Medical Unit

“…Contrary to those studies, another report found no signi cant difference in mortality between patients treated by a hospitalist and those treated by a non-hospitalist [29][30][31][32][33][34]. Moreover, a recent Korean study found no difference in IHM between hospitalist and non-hospitalist care in the integrated medical model [34].…”

“…Despite those con icting results, in our institute, AMU hospitalist care reduced the total LOS, compared to care from non-hospitalists. Recently, another study reported that hospitalist care within the integrated medical model of Korea showed a reduction in LOS, particularly in patients with multiple comorbidities [34]. According to that study, patients that received hospitalist care had shorter LOS, for several reasons.…”

“…Previous studies showed that hospitalist care led to signi cantly lower re-admission rates, compared to nonhospitalist care [10,21,22,29,39,48,50]. Others found no signi cant difference in the re-admission rate [30,[32][33][34][40][41][42][43][44]. Those results suggested that the re-admission rate might depend on the type of hospitalist care model applied, disease-related factors, and the hospitalist's roles.…”

“…Previous studies that investigated the impact of AMU or hospitalist care have reported that IHM was reduced with hospitalist care [7,8,10,[21][22][23][24][25][26][27][28]. Contrary to those studies, another report found no signi cant difference in mortality between patients treated by a hospitalist and those treated by a non-hospitalist [29][30][31][32][33][34]. Moreover, a recent Korean study found no difference in IHM between hospitalist and non-hospitalist care in the integrated medical model [34].…”

“…According to that study, patients that received hospitalist care had shorter LOS, for several reasons. One reason was that the hospitalists were better trained than residents; consequently, they could manage diseases from more perspectives, which increased the likelihood of resolving the condition [34]. That nding suggested that Korean hospitalist care might signi cantly shorten LOS, regardless of the type of care model applied.…”