Comparison of inpatient subspecialty care delivery models: Clinical outcomes and racial disparities in dedicated versus consultative pulmonary care

BACKGROUND: Subspecialty inpatient care is associated with improved outcomes in various clinical settings. However, clinical outcomes and racial disparities between dedicated inpatient pulmonary care and general medicine services with pulmonary consultation remain unknown.

OBJECTIVE: To compare clinical outcomes between dedicated and consultative inpatient pulmonary care and evaluate whether racial disparities in outcomes differ by care model.

METHODS: Retrospective cohort study of 1072 self-identified Black and White adults admitted to dedicated pulmonary or general medicine services with pulmonary consultation (April 2017-February 2020) at an academic medical center. Exposures included the care model, race, and the interaction between the two. Outcomes included hospital length of stay (LOS; modeled as risk of discharge alive using competing risk models), hospital readmissions, and outpatient pulmonary follow-up. We performed multivariable regression models with interaction terms adjusted for demographics, comorbidities, clinical severity, and pulmonary diagnosis.

RESULTS: Dedicated pulmonary service patients had shorter LOS (subdistribution hazard ratio [SHR]: 1.38, 95% confidence interval [CI]: 1.14-1.67, p = .001) and improved 90-day outpatient follow-up (odds ratio [OR]: 1.63, 95% CI: 1.07-2.49, p = .023). The interaction between care model and race demonstrated significantly lower odds of 30-day follow-up among Black patients admitted to the dedicated service versus those with consultations; no other significant racial disparities in outcomes were demonstrated.

CONCLUSIONS: Dedicated pulmonary inpatient care was associated with shorter hospital LOS and higher 90-day outpatient follow-up without significant racial disparities in most outcomes. Hospitals could consider pilot-testing dedicated inpatient pulmonary care models, as more work is needed to validate these findings in broader settings.

National Heart, Lung, and Blood Institute

Bhavik P Patel, Caitlin B Clancy, Scott D Halpern, Rachel Kohn