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Update in Hospital Medicine
- Karen E. Hauer, MD; and
- Neil Winawer, MD
- From University of California, San Francisco, San Francisco, California; and Emory University, Atlanta, Georgia.
2000-2001 Series: Update Sessions from ACP-ASIM's 2000 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
Structural changes in the health care system have prompted the evolution of hospital medicine as a distinct area of practice that has been defined to include physicians who spend at least 25% of their time practicing inpatient medicine (1). Studies from 1998 showed that care provided by hospital medicine specialists reduced both length of stay and total cost of care by approximately 15% while maintaining quality of care and patient satisfaction (2, 3). A recent workforce analysis projected that the number of practicing hospitalists in the United States could grow from the current 3000–4000 to 19 000 if this model of inpatient care is fully implemented at most hospitals (4).
This Update reviews the key literature from 1999 relevant to the care of hospitalized patients. Clinical advances are summarized in the first five sections. The last sections examine additional issues outside the realm of traditional clinical practice that hospitalists address frequently in providing inpatient medical management, including a summary of research on health care quality and end-of-life care.
Pulmonary Medicine
Steroids Speed Recovery and Shorten Stay for Patients with Chronic Obstructive Pulmonary Disease
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Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med. 1999; 340:1941-7.
Systemic corticosteroid therapy is the mainstay of treatment for reactive airways disease and exacerbations of chronic obstructive pulmonary disease (COPD). However, the efficacy of these drugs with respect to clinical outcomes in acute exacerbations of COPD is not well studied. Niewohner and colleagues conducted a randomized, double-blind, placebo-controlled study to determine whether corticosteroids shortened the duration of a COPD flare and to ascertain the optimum length of treatment.
The inclusion criteria selected for significant …
