A team from New York, USA, investigated the impact of gastroenterology consultation on the outcomes of patients admitted to hospital with decompensated cirrhosis.
Managed care has strongly discouraged generalists from referring patients to specialists in an effort to reduce the costs of health care.
The researchers looked at when generalists work together with gastroenterologists and when they work alone.
A total of 197 consecutive patients, admitted to the authors' hospital with decompensated cirrhosis over a 1-year period, were identified.
Length of stay, cost of hospitalization, incidence of hospital readmission, and mortality for patients who did, and those who did not, have a gastroenterology (GI) consultation were compared.
|Benefits of GI consultation:|
- Shorter hospital stay
- Lower hospitalization cost
- Fewer readmissions
- Lower mortality
A GI consultation was requested for 107 (54%) of the patients.
Patients who had a GI consultation had a significantly shorter length of stay (5.6 vs 10.1 days) and a lower cost of hospitalization ($6004 vs $10,006) than those patients who were managed by generalists alone.
The researchers found that 30-day incidence of readmission (13% vs 28%) and mortality (8% vs 17%) were significantly lower in the GI consultation group.
During a median follow-up of 618 days, patients who had a GI consultation during hospitalization had a significantly longer time to hospital readmission and improved survival compared with those who were managed by generalists alone.
Author Edmund J. Bini, of the VA New York Harbor Healthcare System and NYU School of Medicine, said on behalf of his group, "For patients admitted to the hospital with decompensated cirrhosis, individuals who were managed by generalists in conjunction with gastroenterologists had better outcomes than those who were managed by generalists alone".