Effects of caregiver specialty on cost and clinical outcomes following hospitalization for heart failure.
In 614 consecutive hospitalizations with the primary discharge diagnosis of diagnosis-related group (DRG) 127 (heart failure and shock), we sought to assess the effect of caregiver specialty (generalist, n=217 ; cardiologist, n=397) on hospita costs, length of stay, and in-hospital mortality.
Patients treated by cardiologists were younger (68 vs 71 years) and less likely to have hypertension (52% vs 61%), but were 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 ventricular 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 admission.
Predictors of acute disease severity were similarly distributed between the 2 groups.
No difference was found between patients treated y cardiologists versus those treated by generalists with respect to crude or adjusted hospital cost, length of stay, and in-hospital mortality.
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 y cardiologists was, however, negated by the higher proportion of patients treated by cardiologists who required intensive care during hospitalization. (...)
Mots-clés Pascal : Insuffisance cardiaque, Homme, Spécialité médicale, Coût, Economie santé, Hospitalisation, Evolution, Etude comparative, Médecin, Médecin généraliste, Pronostic, Exploration, Appareil circulatoire pathologie, Cardiopathie
Mots-clés Pascal anglais : Heart failure, Human, Medical specialty, Costs, Health economy, Hospitalization, Evolution, Comparative study, Physician, General practitioner, Prognosis, Exploration, Cardiovascular disease, Heart disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0361527
Code Inist : 002B12A01. Création : 25/01/1999.