Length of stay and costs for hospitalized hemodialysis patients: Nephrologists versus internists

The high cost of hospitalization for hemodialysis patients has become a maj or health care issue. To address this issue, length of hospital stay and co sts for these patients were compared with services covered by nephrologists and services covered by internists. Hemodialysis patients (n = 161) were p rospectively admitted 219 times on alternate days to services covered by ne phrologists or by internists from July 1995 to March 1996 Admissions to non medical services and admissions for overnight observation were excluded. Le ngth of stay, costs, and risk-adjusted predicted length of stay and costs, as well as the number of consultations were compared between services, usin g Wilcoxon rank sum tests. Readmissions and deaths were compared using chi( 2) tests. Mean length of stay for admissions to the nephrology service (n = 114) was 6.3 days compared with 8.1 days for admissions to internal medici ne services (n = 105) (P = 0.017). The predicted length of stay was similar . Mean overall cost for admissions under the care of nephrologists was $7,9 25 versus $10,773 under the care of internists (P = 0.101). The internal me dicine service averaged 1.5 consultations versus 0.5 consultations for the nephrology service (P = 0.001). The risk of readmission was 24% for nephrol ogists and 30% for internists (P = 0.328). Death within 90 days of discharg e was 12% for the nephrology group and 22% for the internal medicine group (P = 0.07). The length of stay was significantly shorter for hemodialysis p atients under the care of nephrologists compared with internists. The avera ge total costs and risk of readmissions tended to be lower for nephrologist s. If these results are corroborated, the care of hemodialysis patients by the nephrologist could diminish the overall expense of the ESRD program.