Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system

Davis, Ken; Koch, Karen; Harvey, Janet; Wilson, Renée; Englert, Jan; Gerard, Patrick D.

doi:10.1016/s0002-9343(00)00362-4

Cited by 89 publications

(75 citation statements)

References 10 publications

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“…Specific data were not reported, but it was noted that there was no statistical difference in satisfaction between those cared for by hospitalists versus PCPs. 28 On the basis of these studies, Wachter and Goldman concluded that ''surveys of patients who were cared for by hospitalists show high levels of satisfaction, no lower than that of similar patients cared for by their own primary physicians.'' 23 Wachter and Goldman's review has been highly cited, and we could find no subsequent studies addressing this issue.…”

Section: Discussionmentioning

confidence: 99%

“…These are potentially important measures of relationship duration, yet whether duration affects patient satisfaction remains undecided. [16][17][18]20,28,30,32,33 We assessed satisfaction using HCAHPS questions, in order to provide objective and meaningful comparisons across hospitals. The HCAHPS instrument, however, is intended to assess patient satisfaction with doctors in general, not with subgroups or individuals, and responses in our study were uniformly high.…”

Section: Discussionmentioning

confidence: 99%

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Patient satisfaction with hospital care provided by hospitalists and primary care physicians

Seiler

Visintainer

Brzostek

et al. 2011

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patient satisfaction with hospital care provided by hospitalists and primary care physicians

Seiler

Visintainer

Brzostek

et al. 2011

Journal of Hospital Medicine

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“…Commonly, hospital-based physicians, including hospitalists, and medical and surgical residents in academic institutions, work exclusively in the hospital and care for the majority of hospitalized patients. [20][21][22][23][24][25][26] Oftentimes, the hospital physician is first introduced to their patient at hospital admission and must rely on the history, physical exam and medical record when making medical decisions. [27][28][29][30][31] For this reason, the hospital physician may be unaware of a patient's drug or alcohol use or mental illness, all risk factors for opioid misuse.…”

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

et al. 2015

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BACKGROUND: Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use. OBJECTIVE: We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge. DESIGN: This was a retrospective cohort study. PARTICIPANTS: From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital. MAIN MEASURE: Chronic opioid use 1 year post discharge. KEY RESULTS: Twenty-five percent of opioid naïve patients (n=1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3 % versus 3.5 %, p<0.001), acute pain (2.7 % versus 1.0 %, p<0.001), chronic pain at admission (12.1 % versus 3.3 %, p<0.001) or surgery during their hospitalization (65.1 % versus 18.4 %, p<0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7 % versus 20.7 %, p<0.001) and mental health disorders (23.9 % versus 31.4 %, p<0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1 % versus 1.3 %, p<0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR=4.90, 95 % CI 3.22-7.45) and greater subsequent opioid refills (AOR=2.67, 95 % CI 2.29-3.13) 1 year post discharge compared to no opioid receipt. CONCLUSION:Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.

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“…Several institutions have demonstrated that both length of stay (LOS) and cost per case (C/C) have been reduced through the use of hospitalists. [1][2][3][4][5][6] On average, hospitalists have been reported to reduce LOS by 16.6% and C/C by 13.4%. 1 Such decreases have been shown in both academic 2,3 and community-based institutions.…”

mentioning

confidence: 99%

“…1 Such decreases have been shown in both academic 2,3 and community-based institutions. [4][5][6] Though economic forces ultimately drive the utilization of hospitalists, other outcomes, such as the benefit of hospitalists on the medical education of internal medicine residents and medical students, have been explored to a limited extent. 7 In one large university medical center, residents expressed satisfaction with the teaching provided by hospitalists and reported that it was equivalent and often superior to that of traditional ward attendings.…”

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confidence: 99%

The positive impact of initiation of hospitalist clinician educators

et al. 2004

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OBJECTIVE:Although hospitalists have been shown to improve both financial and educational outcomes, their ability to manage dual roles as clinicians and educators has been infrequently demonstrated, particularly in the community setting where large numbers of residents train. We evaluated the impact of hospitalists on financial and educational outcomes at a midsized community teaching hospital 1 year after implementation. DESIGN:Two hospitalist clinician educators ( HCEs) were hired to provide inpatient medical care while participating in resident education. Length of stay and cost per case data were calculated for all patients admitted to the hospitalist service during their first year and compared with patients admitted to private physicians. The hospitalists' top 11 discharge diagnoses were individually assessed. For the same time period, categorical medicine residents ( N = 36) were given an anonymous written survey to assess the HCEs' impact on resident education and service. RESULTS:Resource consumption: length of stay was reduced by 20.8% and total cost per case was reduced by 18.4% comparing the HCEs with community-based physicians. Reductions in both length of stay and cost per case were noted for 8 of the 11 most common discharge diagnoses. Resident survey: over 75% of residents responded, with all noting improvement in the quality of attending rounds, bedside teaching, and the overall inpatient experience. Residents' roles as teachers and team leaders were largely unchanged. A driving force behind the expansion of the hospitalist movement is the potential to deliver high-quality medical care while decreasing inpatient costs and improving efficiency. Several institutions have demonstrated that both length of stay (LOS) and cost per case (C/C) have been reduced through the use of hospitalists. CONCLUSION:1-6 On average, hospitalists have been reported to reduce LOS by 16.6% and C/C by 13.4%. 1 Such decreases have been shown in both academic 2,3 and community-based institutions. [4][5][6] Though economic forces ultimately drive the utilization of hospitalists, other outcomes, such as the benefit of hospitalists on the medical education of internal medicine residents and medical students, have been explored to a limited extent. 7 In one large university medical center, residents expressed satisfaction with the teaching provided by hospitalists and reported that it was equivalent and often superior to that of traditional ward attendings. 2 In fact, these residents requested that hospitalists be a part of all of their future inpatient ward rotations. Another university medical center found that the presence of hospitalists improved the quality of attending rounds, increased the emphasis on resident education during inpatient rotations, and enhanced residents' overall learning experience. 8Despite the fact that hospitalists often serve in dual roles as clinicians and educators, there are few data on their ability to effectively manage these roles simultaneously. For academic community-based teaching hospital...

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Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system

Cited by 89 publications

References 10 publications

Patient satisfaction with hospital care provided by hospitalists and primary care physicians

Patient satisfaction with hospital care provided by hospitalists and primary care physicians

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

The positive impact of initiation of hospitalist clinician educators

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