A study published in JAMA Network Open found that hospitalized pediatric patients had similar lengths of stay, total costs, and readmission rates whether treated by either general pediatricians or pediatric hospitalists.
In recent years, the number of pediatric hospitalists has grown substantially, and in 2016, the American Board of Medical Specialties recognized pediatric hospital medicine as an official specialty. Yet, the effectiveness of this specialty in treating hospitalized pediatric patients compared with care by general pediatricians has yet to be established.
Mariam Krikorian Atkinson, PhD, of the Department of Health Policy and Management at the Harvard TH Chan School of Public Health in Boston, Massachusetts, and colleagues used data from the medical records of a US urban academic children’s hospital between January 2009 and August 2015, obtained as part of a larger study examining physician assignment practices, to conduct a cross-sectional study to determine the efficacy of pediatric hospital medicine vs general pediatric hospital care.
The authors investigated the records of 1463 hospitalizations of 726 girls and 697 boys with a mean age of 6.1 years. Hospitalists had cared for 870 of these patients, and general pediatricians cared for 553 patients. The physicians had a mean of 11.1 years of work experience following medical school. Women constituted 58.9% of general pediatricians and 61.5% of hospitalists were women. Although general pediatricians were in practice twice as long as hospitalists (16.0 vs 7.9 years), multivariate models found no significant differences between hospitalists and general pediatricians for patient mean length of stay (4.7 vs 4.6 days), total cost ($14,490 vs $15,200), or 30-day readmission rate (8.9% vs 6.4%). However, device-related adverse events were significantly more frequent among those treated by hospitalists (3.0%) than by general pediatricians (1.1%). This difference became nonsignificant after adjusting for physician experience.
The authors noted that the main limitation of the study was inability to randomize the assignment of patients to hospitalists or general pediatricians. Another limitation was the possibility that not all relevant adverse events were captured.
Dr Atkinson and colleagues concluded by suggesting that device-related adverse events is an area that warrants monitoring, particularly as the pediatric hospital medicine specialty grows.
Atkinson MK, Schuster MA, Feng JY, Akinola T, Clark KL, Sommers BD. Adverse events and patient outcomes among hospitalized children cared for by general pediatricians vs hospitalists. JAMA Netw Open. 2018;1(8):E185658.