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Resource Use and Survival of Patients Hospitalized with Congestive Heart Failure: Differences in Care by Specialty of the Attending Physician

Andrew D. Auerbach, MD, MPH; Mary Beth Hamel, MD, MPH; Roger B. Davis, ScD; Alfred F. Connors Jr., MD; Carol Regueiro, MD; Norman Desbiens, MD; Lee Goldman, MD, MPH; Robert M. Califf, MD; Neal V. Dawson, MD; Neil Wenger, MD; Humberto Vidaillet, MD; Russell S. Phillips, MD, SUPPORT Investigators
[+] Article and Author Information

From Beth Israel Deaconess Medical Center, Boston, Massachusetts; University of Virginia School of Medicine, Charlottesville, Virginia; University of Tennessee College of Medicine, Chattanooga, Tennessee; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Durham, North Carolina; MetroHealth Medical Center, Cleveland, Ohio; University of California at Los Angeles Medical Center, Los Angeles, California; Marshfield Clinic, Marshfield, Wisconsin; and Allegheny General Hospital, Pittsburgh, Pennsylvania.


Presented in part at the annual meeting of the Society of General Internal Medicine, Washington, D.C., 2 May 1997.

Acknowledgments: The authors thank Jane Soukup, MS, for assistance in assembling the database used for this paper.

Grant Support: By the Robert Wood Johnson Foundation. The opinions and findings contained in this manuscript are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or their Board of Trustees.

Requests for Single Reprints: Andrew Auerbach, MD, MPH, Department of Medicine—Box 0120, University of California, San Francisco, San Francisco, CA 94143.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Auerbach and Goldman: Department of Medicine, Box 0120, University of California, San Francisco, San Francisco, CA 94143.

Drs. Hamel, Davis, and Phillips: Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Libby 330, Boston, MA 02215.

Dr. Connors: University of Virginia Health Science Center, Box 600, Charlottesville, VA 22908.

Dr. Regueiro: Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212.

Dr. Desbiens: University of Tennessee College of Medicine—Chattanooga Unit, 921 East Third Street, Suite 400, Chattanooga, TN 37379.

Dr. Califf: Duke Clinical Research Institute, Durham, NC 27705.

Dr. Dawson: Center for Health Research and Policy, Case Western Reserve University at MetroHealth Medical Center, 2500 MetroHealth Drive, R222, Cleveland, OH 44109-1998.

Dr. Wenger: Department of Medicine, University of California at Los Angeles Medical Center, Los Angeles, CA 90095-1736.

Dr. Vidaillet: Department of Cardiology, Marshfield Clinic, Marshfield, WI 54449.

Author Contributions: Conception and design: A.D. Auerbach, M.B. Hamel, C.R. Regueiro, N. Desbiens, L. Goldman, R.M. Califf, N.V. Dawson, H. Vidaillet, R.S. Phillips.

Analysis and interpretation of the data: A.D. Auerbach, R.B. Davis, A.F. Connors, N. Desbiens, L. Goldman, R.M. Califf, N.V. Dawson, H. Vidaillet, R.S. Phillips.

Drafting of the article: A.D. Auerbach, R.S. Phillips.

Critical revision of the article for important intellectual content: A.D. Auerbach, M.B. Hamel, R.B. Davis, A.F. Connors, N. Desbiens, L. Goldman, R.M. Califf, N.V. Dawson, N. Wenger, H. Vidaillet, R.S. Phillips.

Final approval of the article: A.D. Auerbach, M.B. Hamel, R.B. Davis, A.F. Connors, N. Desbiens, L. Goldman, R.M. Califf, N.V. Dawson, N. Wenger, H. Vidaillet, R.S. Phillips.

Provision of study materials or patients: A.F. Connors, N. Desbiens, L. Goldman, R.M. Califf, N.V. Dawson, N. Wenger, H. Vidaillet, R.S. Phillips.

Statistical expertise: R.B. Davis, A.F. Connors.

Obtaining of funding: N. Desbiens, L. Goldman, R.M. Califf, H. Vidaillet, R.S. Phillips.

Administrative, technical, or logistic support: R.S. Phillips.

Collection and assembly of data: A.D. Auerbach, A.F. Connors, N. Desbiens, L. Goldman, R.M. Califf, N.V. Dawson, N. Wenger, H. Vidaillet, R.S. Phillips.


Ann Intern Med. 2000;132(3):191-200. doi:10.7326/0003-4819-132-3-200002010-00004
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In an effort to contain costs, many health networks have adopted strategies that increase utilization of primary care physicians and limit referrals to specialty care (1). This tactic is intended to encourage less resource-intensive patient care provided by generalists (2).

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Figures

Grahic Jump Location
Figure.
Adjusted survival among patients with congestive heart failure cared for by cardiologists (dashed line) and generalists (solid line), calculated by using Cox proportional-hazards models.

The number of patients alive at the end of each time period and at maximum follow-up (31 December 1994) is shown below the figure.

Grahic Jump Location

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Summary for Patients

Differences in Care That Doctors with Different Specialties Give Patients with Congestive Heart Failure

The summary below is from the full report titled “Resource Use and Survival of Patients Hospitalized with Congestive Heart Failure: Differences in Care by Specialty of the Attending Physician.” It is in the 1 February 1999 issue of Annals of Internal Medicine (volume 132, pages 191-200). The authors are A.D. Auerbach, M.B. Hamel, R.B. Davis, A.F. Connors Jr., C. Regueiro, N. Desbiens, L. Goldman, R.M. Califf, N.V. Dawson, N. Wenger, H. Vidaillet, and R.S. Phillips, for the SUPPORT Investigators.

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