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Comparison of specialist and generalist care.
- Source :
-
Australian Health Review . 2018, Vol. 42 Issue 5, p579-583. 5p. - Publication Year :
- 2018
-
Abstract
- Objective: The choice of whether to admit under a specialist or a generalist unit is often made with neither clear rationale nor understanding of its consequences. The present study compared the characteristics and outcomes of patients admitted with community-acquired pneumonia to either a general medicine or respiratory unit. Methods: This study was a retrospective cross-sectional study using data from public hospitals in Adelaide, South Australia. Over 5 years there were 9775 overnight, unplanned appropriate adult admissions. Patient length of hospital stay, in-patient mortality rate and 30-day unplanned readmission rate were calculated, with and without adjustment for patient age and comorbidity burden. Results: Over 80% of these patients were cared for by a general medicine unit rather than a specialist unit. Patients admitted to a general medicine unit were, on average, 4 years older than those admitted to a respiratory unit. Comorbidity burdens were similar between units at the same hospital. Length of in-patient stay was >1 day shorter for those admitted to a general medicine unit, without significant compromise in mortality or readmission rates. Between each hospital, general medicine units showed a range of mortality rates and length of hospital stay, for which there was no obvious explanation. Conclusions: Compared with speciality care, general medicine units can safely and efficiently care for patients presenting to hospital with community-acquired pneumonia. What is known about the topic?: Within the narrow range of any specific disease, generalist medical services are often cited as inferior in performance compared with a speciality service. This has implications for hospital resourcing, including both staffing and ward allocation. What does this paper add?: This paper demonstrates that most patients admitted with a principal diagnosis of community-acquired pneumonia were admitted to a generalist unit and did not apparently fare worse than patients admitted to a specialist service; patients admitted to a generalist unit spent less time in hospital and there was no difference in mortality or readmission rate compared with patients admitted to a specialist service. What are the implications for practitioners?: The provision of generalist services at urban hospitals in Australia provides a safe alternative admission option for patients presenting with pneumonia, and possibly for other common acute medical conditions. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CHI-squared test
*CONFIDENCE intervals
*LENGTH of stay in hospitals
*HOSPITAL wards
*HOSPITAL admission & discharge
*HOSPITAL respiratory services
*INTERNAL medicine
*EVALUATION of medical care
*PATIENTS
*PUBLIC hospitals
*QUESTIONNAIRES
*MATHEMATICAL variables
*COMORBIDITY
*LOGISTIC regression analysis
*MULTIPLE regression analysis
*COMMUNITY-acquired pneumonia
*CROSS-sectional method
*RETROSPECTIVE studies
*PATIENT readmissions
*DATA analysis software
*DESCRIPTIVE statistics
*ODDS ratio
*KRUSKAL-Wallis Test
*EVALUATION
Subjects
Details
- Language :
- English
- ISSN :
- 01565788
- Volume :
- 42
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Australian Health Review
- Publication Type :
- Academic Journal
- Accession number :
- 132210943
- Full Text :
- https://doi.org/10.1071/AH17197