Cross‐sectional analysis of hospitalist prevalence and quality of care in California

Abstract

BACKGROUND:Hospital leaders usually provide financial support to hospitalists groups, often with an expectation of improved performance on publicly reported quality metrics. Whether the presence of hospitalists is associated with differences in hospital‐level performance is unknown.OBJECTIVE:Assess the relationship between hospitalist prevalence and quality performance.DESIGN:Cross‐sectional study.PARTICIPANTS:A total of 208 California hospitals participating in a voluntary reporting initiative.INTERVENTION:Survey of hospital personnel with knowledge of the utilization of hospitalists for patient care.MEASUREMENTS:Sixteen publicly reported quality process measures across 3 medical conditions: acute myocardial infarction (AMI); congestive heart failure (CHF); and pneumonia. Using multivariable models, we assessed the relationship between the presence of hospitalists and the percentage of missed quality opportunities for each process measure.RESULTS:Of 208 eligible hospitals, 170 (82%) had hospitalist services. After adjustment, hospitals with hospitalists had similar performance for cardiac and pneumonia measures assessed at admission and fewer missed processes for CHF measures assessed at discharge. Among sites with hospitalists, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P < 0.001) missed quality opportunities for AMI at admission, and 0.6% (P < 0.001), 0.5% (P = 0.004), and 1.5% (P = 0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively.CONCLUSIONS:The presence of hospitalists in California was associated with modest improvements in performance on publicly reported process measures. Whether hospitalists directly improve quality or simply reflect a hospital's level of investment in quality remains a subject for future study. Journal of Hospital Medicine 2010;5:200–207. © 2010 Society of Hospital Medicine.

Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

“…Seventy-seven articles met these initial inclusion criteria. Upon examination of the full papers, five of these articles were excluded because control patients received significant cross-over of care from the hospitalist physicians [30-34], and three other articles were excluded because healthcare quality was examined among hospitals with and without hospitalists, regardless of whether the sampled patients actually received direct hospitalist care [35-37]. Two papers were excluded because the intervention involved the addition of a hospitalist medical director, as opposed to a hospitalist physician, providing direct inpatient care [38,39], and one paper was excluded because the intervention did not meet a widely accepted definition of a hospitalist program in that no physician spent more than 25% of his or her professional time working as an inpatient specialist [40].…”

Hospitalist utilization and hospital performance on 6 publicly reported patient outcomes

“…Our survey was adapted from the survey developed by Vasilevskis et al [6]. The entire survey can be found in the Appendix.…”

“…2) Approximately what percent of all medical patients in your hospital are admitted by hospitalists? The latter question was intended as an approximation of the intensity of hospitalist use, and has been used in prior studies [6,14]. A more direct measure was not feasible given the complexity of obtaining admission data for such a large and diverse set of hospitals.…”

“…More recently, Vasilevskis et al assessed the association between the intensity of hospitalist use (measured as the percent of patients admitted by hospitalists) and performance on process measures. In a cohort of 208 California hospitals they found a significant improvement in performance on process measures in patients with acute myocardial infarction, heart failure and pneumonia with increasing percentages of patients admitted by hospitalists[6]. …”

Impact of Obstetrician/Gynecologist Hospitalists on Quality of Obstetric Care (Cesarean Delivery Rates, Trial of Labor After Cesarean/Vaginal Birth After Cesarean Rates, and Neonatal Adverse Events)

“…Nonetheless, later multiple studies regarding internal medicine hospitalists have shown improvement in care quality for pneumonia, myocardial infarction, and hospital stay, and readmission rates. 3,4 With these quality and known workplace improvements, the utilization of hospitalists now covers a quarter of all Medicare admissions and has increased by 25% from 2009 to 2011. 5 The obstetric hospitalist movement initially developed in a similar means with limited early data, but is now progressing toward measurement of its effects on patients.…”