McGann K P, Bowman M A, Davis S W
Department of Family and Community Medicine, Bowman Gray School of Medicine, Winston-Salem 27157-1084, USA.
J Fam Pract. 1995 May;40(5):443-8.
In an atmosphere of cost containment, an important question is whether there are differences in quality or cost of medical care provided by physicians with different specialty training.
This study is an analysis of Pennsylvania hospital admissions from the 1989 MedisGroups Comparative Database, consisting of 31,321 hospital admissions by internists and family physicians. It encompasses the top 10 admission diagnostic-related groups in patients 65 years and older. Outcome measures of morbidity, mortality, length of stay, and hospital charges were compared between patients of internists and family physicians while controlling for patient variables, such as age, sex, Medicaid insurance payment, admission from nursing home, and admission severity scores, and hospital characteristics, such as number of beds, teaching status, and available technologies and procedures.
Admission diagnoses were similar for patients of family physicians and internists. After adjusting for relevant patient and hospital characteristics, there were no differences in mortality or hospital charges; however, the patients of internists experienced slightly higher morbidity (odds ratio = 1.07, 95% confidence interval, 1.017 to 1.123) and longer mean length of stay (10.80 vs 10.54 days, P < .05). The mean age of patients and the proportion of Medicaid patients was similar in the two specialty groups. Family physicians' patients were more likely to be female (60% vs 57%, P < .01), were less likely to be admitted from nursing homes (4% vs 5%, P < .01), and had a lower mean admission severity score (1.940 vs 1.964 on a scale of 0 [least seriously ill] to 4 [most seriously ill], P < .01). Internists were more likely to work in teaching hospitals and hospitals with sophisticated technology (P < .01).
It makes little difference in medical outcomes or hospital charges whether family physicians or internists manage the hospital care of elderly patients for common medical problems. Previously documented lower costs of care by family physicians may be due to outpatient rather than inpatient care.
在成本控制的大环境下，一个重要问题是接受不同专科培训的医生所提供的医疗服务在质量或成本上是否存在差异。
本研究对宾夕法尼亚州1989年医疗分组比较数据库中的医院入院病例进行分析，该数据库包含内科医生和家庭医生的31321例医院入院病例。研究涵盖65岁及以上患者中排名前十的入院诊断相关组。在控制患者变量（如年龄、性别、医疗补助保险支付、来自疗养院的入院情况以及入院严重程度评分）和医院特征（如床位数量、教学状况以及可用技术和程序）的同时，比较内科医生和家庭医生的患者在发病率、死亡率、住院时间和医院费用等结局指标方面的差异。
家庭医生和内科医生的患者入院诊断相似。在对相关患者和医院特征进行调整后，死亡率或医院费用没有差异；然而，内科医生的患者发病率略高（优势比 = 1.07，95%置信区间为1.017至1.123），平均住院时间更长（10.80天对10.54天，P < 0.05）。两个专科组患者的平均年龄和医疗补助患者的比例相似。家庭医生的患者女性比例更高（60%对57%，P < 0.01），从疗养院入院的可能性更小（4%对5%，P < 0.01），平均入院严重程度评分更低（在0[病情最轻]至4[病情最重]的量表上为1.940对1.964，P < 0.01）。内科医生更有可能在教学医院和拥有先进技术的医院工作（P < 0.01）。
对于老年患者常见医疗问题的住院治疗，由家庭医生还是内科医生管理，在医疗结局或医院费用方面几乎没有差异。先前记录的家庭医生较低的医疗成本可能归因于门诊而非住院治疗。
