Care by "hospitalists" in U.S. growing: study

NEW YORK Wed Mar 11, 2009 10:26pm EDT

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NEW YORK (Reuters Health) - In the past 10 years, there has been a marked increase in the proportion of hospitalized patients being managed by "hospitalists," according to a report in this week's issue of The New England Journal of Medicine.

A hospitalist is a hospital-based general physician. Hospitalists assume the care of a hospitalized patient in place of the patients' primary care doctor.

"The rapid growth of care by hospitalists exemplifies the dynamic nature of medical care in the United States in recent years," Dr. Yong-Fang Kuo, from the University of Texas Medical Branch, Galveston, and co-researchers wrote.

In an analysis of Medicare data, Kuo and colleagues found that, from 1995 to 2006, the percentage of claims for internist services provided by hospitalists rose from 9.1 percent to 37.1 percent.

At the same time, the percentage of hospitalized patients treated by any general internist, both hospitalist and non-hospital-based doctors, climbed from 46.4 percent to 61.0 percent.

From a 5 percent sample of Medicare beneficiaries, the researchers identified 120,226 internal medicine physicians who provided care to older patients at 5800 US hospitals during the study period. Hospitalists were defined as doctors who derived at least 90 percent of their Medicare claims from services provided to hospitalized patients.

From 1995 to 2006, the percentage of internists who were hospitalists increased from 5.9 percent to 19.0 percent, the investigators found.

They also found that the likelihood of receiving care from a hospitalist rose by 29.2 percent each year from 1997 to 2006.

An analysis of 2006 data showed that the extent of hospitalist care varied greatly by geographic region. Hospital-referral areas with the highest percentages of hospitalist care were St. Cloud, Minnesota (85.6 percent), Mesa, Arizona (84.0 percent), and Appleton, Wisconsin (81.6 percent).

SOURCE: The New England Journal of Medicine, March 12, 2009.

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