octors who specialize in treating patients in the hospital can reduce death rates and costs, but only as the doctors develop greater experience, a small study suggests.

Published last week in The Annals of Internal Medicine, the study examined the record of a new specialist, the "hospitalist."

While internists traditionally see their hospitalized patients before or after office hours or on a rotation of shared coverage, hospitalists make hospital patient care a more significant focus ó by one definition, at least 25 percent of their time, the study said.

Advertisement

To test the effectiveness of the new approach, researchers at the University of Chicago enlisted two internists to work as hospitalists in alternate months for two years. More than 6,000 patients were randomly assigned to them or to the general medical service, in which 58 internists worked a rotation as attending physicians.

In the first year, hospital stays were slightly shorter for patients cared for by a hospitalist, but costs and deaths were about the same.

In the second year, gaps opened: 4 percent of the hospitalists' patients died within 30 days of leaving the hospital compared with 6 percent of the patients attached to the general service; hospital stays were a half-day shorter for the hospitalists' patients and costs per patient were $782 lower.

Dr. David Meltzer, the study's lead author, said the drop in deaths was primarily related to the hospitalists' more rapid accumulation of experience in asthma, pneumonia and congestive heart failure.

He cautioned against drawing too many conclusions from a small study in an academic medical center. But he suggested that hospitals and medical groups planning to use the specialists "work very hard to hire and then retain experienced hospitalists" and set up ways of formally monitoring their effectiveness.