A COMPARISON OF GENERALIST AND PULMONOLOGIST CARE FOR PATIENTS HOSPITALIZED WITH SEVERE CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - RESOURCE INTENSITY, HOSPITAL COSTS, AND SURVIVAL

PURPOSE: Both generalist and pulmonologist physicians care for patient s with severe chronic obstructive pulmonary disease (COPD). We studied patients hospitalized with severe COPD to explore whether supervision of care by pulmonologists is associated with greater costs or better survival. SUBJECTS AND METHODS: We studied 866 adults with severe COPD enrolled in the Study to Understand Prognoses and Preferences for Out comes and Risks of Treatments (SUPPORT), a prospective study at five a cademic medical centers. Patients were admitted to the hospital or tra nsferred to an intensive care setting for treatment of severe COPD, de fined by hypoxia (PaO2 <60 mm Hg) and hypercapnia (PaCO2 >50 mm Hg) or hypercapnia alone if on supplemental oxygen. Resource intensity was m easured using a modified version of the Therapeutic Intervention Scori ng System and estimated hospital costs. To account for differences in the patient case mix, propensity scores were developed to represent ea ch patient's probability of having a pulmonologist as attending physic ian and each patient's probability of being in an intensive care unit (ICU) at study admission. RESULTS: Of the 866 patients studied, 512 ha d generalists and 354 pulmonologists as their attending physicians. Th e median patient age was 70 years; 52% were male; 14% died within 30 d ays. After adjusting for baseline differences in patient characteristi cs, there were no differences in resource intensity and hospital costs in those treated by pulmonologists or generalists, Adjusted average r esource intensity scores for the entire hospitalization were 16.5 for pulmonologists and 17.0 for generalists (P = 0.34). Estimated hospital costs were the same ($6,400) for patients treated by pulmonologists a nd generalists (P = 0.99). Patients with pulmonologists as attending p hysicians did not experience better survival. Comparing patients of pu lmonologists to patients of generalists, the adjusted hazard ratio for 30-day mortality was 1.6 (95% confidence interval: 0.98, 2.5); the ha zard ratio for 180-day mortality was 1.2 (0.9, 1.7).CONCLUSIONS: Our f indings suggest that for patients hospitalized with exacerbation of se vere COPD, those with pulmonologist attending physicians do not have h igher hospital resource use or better survival than those with general ist attending physicians. (C) 1998 by Excerpta Medica, Inc.