Am Heart Hosp J. 2011;9(2):81–6
Lozenge Reference
Original Contribution
Should a Cardiologist be the Principal Attending Physician or the Consultant to a Hospitalist or General Internist for Cardiovascular Disease Admissions?
George Everett, MD, MS1 and Nizam Uddin, PhD2
Cardiologists may be the principal attending physician or the consultant to general internists or hospitalists in hospitalized patients with cardiovascular diseases. To find out which role may be best for quality and efficiency, a retrospective cohort study of 15,113 patients in 11 cardiovascular diagnosis groups was carried out. Hospital cost, length of stay, mortality, and 30-day readmissions were compared among attending physicians who were hospitalists, general internists, or cardiologists. After adjustment for differences in demography and severity, cardiologists generally had substantially lower cost and length of stay compared with internists or hospitalists, especially when the diagnosis group included a cardiovascular procedure. Hospitalists and internists did not differ substantially in cost or length of stay. There were no statistically significant differences among the physician groups in mortality or 30-day readmissions. In conclusion, cardiologists may be the more efficient attending physician for selected cardiovascular diseases, especially when procedures are involved.
ospitalists, general internists and family physicians often serve as managers of hospital patients. This role has rapidly expanded for hospitalists in the US. In some instances the general physician has the lead role as attending physician seeking consultation with other specialist physicians. In other cases the specialist may be the attending physician and seek the additional support of the primary care physician or hospitalist. The benefit of this approach has been demonstrated in a few specific instances. Orthopedists and hospitalists co-managed patients with hip and knee arthroplasty with evidence of lower complication rates, but not lower costs or length of stay (LOS).1
H In two studies,2,3 orthopedist and hospitalist
care of hip fractures resulted in marginally beneficial cost and efficiency trends in one study2 in the other study.3
and reduced LOS
While medical and surgical specialists may complement one another’s knowledge and skills, the same may not be equally
Cardiovascular disease is the most common category of illness in hospitalized adult populations in the US. Relatively few studies have examined the efficiency or quality of hospital care as to whether a cardiologist or internist is the best principal attending physician for cardiovascular diseases and most studies have focused on
• 1. Program Director, Internal Medicine Residency Program, Florida Hospital Medical Center; 2. Professor of Statistics, University of Central Florida
• Disclosure: This article was funded by Orlando Health, 1414 Kuhl Avenue, Orlando, FL 32806. The Institutional Review Board of Orlando Health approved the research. The authors have no conflicts of interest to declare.
• Correspondence: George Everett, MD, MS, 2501 North Orange Avenue, Orlando, FL 32804. E:
george.everett.md@
flhosp.org Winter 2011 Finding a Cardiologist’s Most Efficient and Effective Role 81
true for general internal medicine physicians and internal medicine subspecialists, because the basic training of subspecialists includes general internal medicine. It is a common practice in hospitals throughout the US to have internal medicine physicians (general internists or hospitalists) act as principal attending physicians of patients who require medical subspecialty care. In these circumstances, the medical subspecialist is a consultant. The alternative situation arises when the medical subspecialist becomes the principal attending physician for the patient and may or may not ask a hospitalist or general internist to consult on the case.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68