Hospitals + hospitalists = better heart attack care

Hospitals with hospitalists seem to deliver better quality care than those without, especially in cases of myocardial infarction. This is based on a study by Massachusetts General Hospital researchers reported in the recent issue of Archives of Internal Medicine. But wait a minute… what are hospitalists?

The term “hospitalist” is rather new, so new that one cannot find it in the Medline medical encyclopedia. According to the Society of Hospital Medicine,

hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital care.The majority of hospitalists (85%) are specialized in general internal medicine and some underwent extra training pulmonary/critical care.

The study looked at 3619 hospitals and medical centers in the US. It compared two groups of hospitals, one group which employed hospitalists (N=1461, 40%) and another group which did not (60%).

The two groups of hospitals were assessed based on health care provided in patients who suffered from heart attack, heart failure and pneumonia, which are the three most common clinical diagnoses in inpatients in the US. The researchers looked at the performance of the hospitals in treatment and diagnosis, and counseling and prevention of these 3 conditions for a one-year follow up period.

The results indicate that hospitals with hospitalists scored better in evaluations that reflect adherence to Hospital Quality Alliance (HQA) care measures for acute heart attack and pneumonia. Other differences also noted. In general, hospitals employing hospitalists

• are more likely to be private, nonprofit teaching centers with at least 200 beds.
• are more likely to have intensive care units.
• have fewer Medicare patients and more Medicaid patients
• had higher nurse-staffing ratios and more nurses per patient-hour

The hospitals with hospitalists scored much better in the care and treatment of patients of with heart attack and pneumonia but not those with heart failure.

Those who had the lowest scores were hospitals which were public and with fewer that 50 beds.

The results indicate that hospitalists and nurses do play an important role in delivering quality care to patients. However, the researchers warn from jumping into conclusions. According to co-author Dr Leroi S Hicks

“We’re not saying it was the hospitalists themselves who improved the quality of care in these conditions. We adhered very closely to saying that if having a hospitalist were itself a metric, there’s something about these hospitals that is associated with better care.”

Other factors, including bedside manners, as well as the difference between outcomes in heart attack and heart failure, need to be looked into.