EFFECTS OF CAREGIVER SPECIALTY ON COST AND CLINICAL OUTCOMES FOLLOWING HOSPITALIZATION FOR HEART-FAILURE

In 614 consecutive hospitalizations with the primary discharge diagnos is of diagnosis-related group (DRG) 127 (heart failure and shock), we sought to assess the effect of caregiver specialty (generalist, n = 21 7; cardiologist, n = 397) on hospital costs, length of stay, and in-ho spital mortality. Patients treated by cardiologists were younger (68 v s 71 years) and less likely to have hypertension (52% vs 61%), but wer e more likely to be men (61% vs 44%), require an intensive care stay ( 13% vs 5%), have coronary artery disease (49% vs 23%), have a left ven tricular ejection fraction <40% (74% vs 49%), and have lower systolic (132 vs 146 mm Hg) and diastolic (76 vs 81 mm Hg) blood pressures on a dmission. Predictors of acute disease severity were similarly distribu ted between the 2 groups. No difference was found between patients tre ated by cardiologists versus those treated by generalists with respect to crude or adjusted hospital cost, length of stay, and in-hospital m ortality. However, in subsets of patients who required intensive care during hospitalization (n = 64), as well as those who did not (n = 550 ), care by cardiologists was associated with a lower adjusted hospital cost Any potential cost savings that could have accrued from care by cardiologists was, however, negated by the higher proportion of patien ts treated by cardiologists who required intensive care during hospita lization. We conclude that when differences in clinical variables are adjusted, care by cardiologists versus generalists is associated with similar or lower hospital cost for patients with DRG 127. Our findings challenge the notion that in-patient care provided by specialists is more expensive than that provided by generalists. (C) 1998 by Excerpta Medico, Inc.