Tuesday, April 8, 2008

Patients Who See Multiple Physicians Have Lengthier Hospital Stays

An analysis of more than 10,000 hospitalized patient reveals that seeing different physicians (Hospitalists) prolongs patient hospital stays. The practice of acquiring hospital-based physicians to evaluate and treat patients may not be as beneficial for patients as it is for doctors.

Obtaining follow up appointments has also been identified as a quality of care issue. Study author, Kenneth R. Epstein, MD, from IPC The Hospitalist Company Inc, North Hollywood, California has defined the dilemma as fragmentation of care, or FOC, explaining: ...”if a patient who was hospitalized for 5 days saw 1 doctor for 3 days and other doctors the other 2 days, FOC would be 2 of 5, or 40%."

Dr. Epstein analyzed the medical records of patients across 16 states - 1724 patients admitted with pneumonia and complications, and 8509 patients admitted with heart failure and shock. Hospital admissions were between December 2006 and November 2007. The patients stayed at 223 hospitals. He concluded that greater fragmentation of care resulted in longer hospital stays for all patients with pneumonia and heart failure.

The exact reason for the extra days in the hospital is only speculative. Bryan Huang, MD, assistant clinical professor of medicine at the University of California, San Diego, says it is "anyone's guess, but there's no way to convey 100% of the information each time you hand off a patient to someone else. Dr. Huang says, “You don't know what the previous day was like, admitting that he is always reluctant to discharge a patient on the first day he has assumed care.

The use of Hospitalists has had a positive impact on clinicians by promoting a healthy work-life balance, " but much less focus has been given to the impact of discontinuity of care on patient length of stay and other utilization and quality metrics,according to Dr. Epstein.

If you find yourself or a family member in the hospital, you may want to discuss discharge plans before the “hand off”.

J Hosp Med. 2008;3(suppl 1):11.

Fight Obesity with "Average" Night's Sleep

A new study, prompted by the current obesity epidemic, has researchers examining sleep duration and the impact on weight gain. According to the authors, Jean-Philippe Chaput, MSc, from Laval University in Quebec City, Quebec, Canada, and colleagues:. "Current treatments for obesity have been largely unsuccessful in maintaining long-term weight loss, suggesting the need for new insight into the mechanisms that result in altered metabolism and behavior and may lead to obesity."

It seems that as sleep times have diminished, we have gotten heavier. Past studies have shown that obesity is linked to lack of sleep. The results of the current study show that short duration sleep (5-6 hrs) or long duration (9-10 hrs) sleep may both contribute to weight gain.

Adults, age 21 to 64, who enrolled in the Quebec Family Study, were questioned about their sleep habits. Body composition was measured at baseline. Over half of the participants had at least one parent and one offspring with inccreased body mass index (BMI 32 or greater). The group was divided into short, average and long duration sleep times, and was followed for six years. Resting metabolic rates and energy intake was similar in each of the participants. Those who slept less were more physically active. Self reported variables also included gender, smoking habits, shift work, age, employment, total income, menopausal status, and coffee intake.

The group that got an average amount of sleep (7-8 hrs) stayed the slimmest, while the short and long duration sleepers experienced an 88% and 71% increase in body weight respectively. Body fat increased 58% for short sleepers and 94% for long sleepers.

The study is possibly limited by factors that include self-reporting and small study samples. Underlying problems such as sleep disturbed breathing and insomnia should be considered, as well as the role of genetics and obesity.

The authors conclude…” these results, emphasize the need to add sleep duration to the panel of determinants that contribute to weight gain and obesity."
Sleep. 2008;31:517-523. ◦