In the Literature: HM-Related Research You Need to Know

The Hospitalist. 2010 December;2010(12):

December 1, 2010 | The Hospitalist

Kelly Cunningham, MD ; Joshua Labrin, MD ; Amanda Salanitro, MD, MSPH ; Kelly Sopko, MD ; Shelley Ellis, MD, MPH ; Elizabeth Rice, MD ; Section OF

Bottom line: High-dose PPIs did not demonstrate reduced rates of ulcer rebleeding, surgical intervention, or mortality compared with non-high-dose PPIs in this meta-analysis, which included a small number of studies and patients.

Citation: Wang CH, Ma MH, Chou HC, et al. High-dose vs. non-high-dose proton pump inhibitors after endoscopic treatment in patients with bleeding peptic ulcer: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2010;170(9):751-758.

Clinical Short

BEDSIDE ULTRASONOGRAPHY COMPARABLE TO RADIOLOGY ULTRASONOGRAPHY FOR ACUTE CHOLECYSTITIS

This single-site observational study found that ultrasonography performed by ED physicians had similar test characteristics to radiology ultrasonography, such that negative bedside ultrasounds seldom resulted in cholecystectomy or admission for acute cholecystitis.

Citation: Summers SM, Scruggs W, Menchine MD, et al. A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis. Ann Emerg Med. 2010;56(2):114-122.

Hospital Utilization by Practicing Generalists Declined before the Emergence of Hospitalists

Clinical question: What has been the pattern of hospital utilization by generalists before and after the emergence of hospitalists?

Background: It has been proposed that the emergence of hospitalists has “crowded out” generalist physicians from the U.S. hospital setting. This study evaluated the trends of inpatient practice by generalists both before and after the emergence of hospitalists.

Study design: Retrospective analysis of national databases.

Setting: U.S. data from 1980 to 2005.

Synopsis: Utilizing the National Hospital Discharge Survey and the American Medical Association’s Physician Characteristics and Distribution in the U.S., information was extracted to evaluate the average number of annual inpatient encounters relative to generalist workforce from 1980 to 2005. Total inpatient encounters for each year were calculated by multiplying the total number of hospital admissions by the average hospital length of stay. The emergence of hospitalists was defined as beginning in 1994.

Total inpatient encounters by generalists declined by 35% in the pre-hospitalist era but remained essentially unchanged in the hospitalist era. During the pre-hospitalist period, the number of generalists doubled, to more than 200,000 from approximately 100,000, while the number of hospital discharges remained relatively stable and the length of stay declined by a third. The decrease in average inpatient encounters in the pre-hospitalist era is thought to have been secondary to decreased length of stay and increased workforce.

Bottom line: Hospital utilization relative to generalist physician workforce was decreasing prior to the emergence of hospitalists mainly due to decreased length of hospital stay and increased numbers of physicians.

Citation: Meltzer DO, Chung JW. U.S. trends in hospitalization and generalist physician workforce and the emergence of hospitalists. J Gen Intern Med. 2010;25(5):453-459.

Clinical Shorts

HOSPITALISTS PERFORM MORE PROCEDURES THAN NONHOSPITALISTS BUT DO NOT PERFORM ALL CORE COMPETENCY PROCEDURES

This secondary analysis of a cross-sectional survey of general internists revealed that more hospitalists perform inpatient procedures than nonhospitalists, but only a small percentage of hospitalists (11%) perform all nine of the SHM core competency procedures.

Citation: Thakkar R, Wright SM, Alguire P, Wigton RS, Boonyasai RT. Procedures performed by hospitalist and non-hospitalist general internists. J Gen Intern Med. 2010;25(5):448-452.

CORTICOSTEROIDS DO NOT IMPROVE OUTCOMES IN HOSPITALIZED PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

Randomized, placebo-controlled, double-blind trial finds no benefit to daily prednisolone as an adjunct to antibiotics in the management of hospitalized patients with community-acquired pneumonia.

Citation: Snijders D, Daniels JMA, de Graff CS, van der Werf TS, Boersma WG. Efficacy of corticosteroids in community-acquired pneumonia: a randomized double-blinded clinical trial. Am J Respir Crit Care Med. 2010;181(9):975-982.

Fragmentation of Hospitalist Care Is Associated with Increased Length of Stay

Clinical question: Does fragmentation of care (FOC) by hospitalists affect length of stay (LOS)?