Morbidity, mortality, and charges for hospital care of the elderly: a comparison of internists' and family physicians' admissions.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.