Outcomes of Care by Hospitalists, General Internists, and Family Physicians

Lindenauer, Peter K.; Rothberg, Michael B.; Pekow, Penelope S.; Kenwood, Christopher T.; Benjamin, Evan M.; Auerbach, Andrew D.

doi:10.1056/nejmsa067735

Cited by 208 publications

(210 citation statements)

References 29 publications

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“…Some authors have reported a reduction in mortality rates associated with hospitalist care and have suggested that physician inpatient specialization might be beneficial to patients, 19,35 whereas other research has failed to identify a benefit. 13,34,36 Our finding that physician tendency toward short LOS, after adjusting for other physician characteristics including hospitalist care, is associated with worse patient outcomes suggests that the potential benefits of hospitalist care (i.e., inpatient specialization) may be offset by the harms associated with shorter LOS.…”

Section: Discussionmentioning

confidence: 94%

“…In order to shorten LOS, many hospitals employ hospitalists to care for inpatients in medical 13,19,[34][35][36] and pediatric [37][38][39] services. Some authors have reported a reduction in mortality rates associated with hospitalist care and have suggested that physician inpatient specialization might be beneficial to patients, 19,35 whereas other research has failed to identify a benefit.…”

Section: Discussionmentioning

confidence: 99%

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Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

Southern

Arnsten

2015

J GEN INTERN MED

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

Southern

Arnsten

2015

J GEN INTERN MED

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“…However, this theory must be tempered by the conclusion from earlier work that did not show a large difference in outcomes among patients cared for by hospitalists. 25 Another reason for the lower claims rate could be a direct result of how hospitalist jobs are structured. In prior research, an inadequate physician-patient relationship has been found to be a factor in patients deciding to file a malpractice claim.…”

Section: Schaffer Et Al | Liability Of Hospitalist Model Of Carementioning

confidence: 99%

Liability impact of the hospitalist model of care

Schaffer

Puopolo²,

Raman³

et al. 2014

Journal of Hospital Medicine

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BACKGROUND An increasingly large proportion of inpatient care is provided by hospitalists. The care discontinuities inherent to hospital medicine raise concerns about malpractice risk. However, little published data exist on the medical liability risks associated with care by hospitalists. OBJECTIVE We sought to determine the risks and outcomes of malpractice claims against hospitalists in internal medicine. DESIGN Retrospective observational analysis. MEASUREMENTS Using claims data from a liability insurer‐maintained database of over 52,000 malpractice claims, we measured the rates of malpractice claims against hospitalists compared to other physician specialties, types of allegations against hospitalists, contributing factors, and the severity of injury in and outcomes of these claims. RESULTS Hospitalists had a malpractice claims rate of 0.52 claims per 100 physician coverage years (PCYs), which was significantly lower than that of nonhospitalist internal medicine physicians (1.91 claims per 100 PCYs), emergency medicine physicians (3.50 claims per 100 PCYs), general surgeons (4.70 claims per 100 PCYs), and obstetricians‐gynecologists (5.56 claims per 100 PCYs) (P < 0.001 for all comparisons). The most common allegation types made against hospitalists were for errors in medical treatment (41.5%) and diagnosis (36.0%). The most common contributing factors underlying claims were deficiencies in clinical judgment (54.4%) and communication (36.4%). Of the claims made against hospitalists, 50.4% involved the death of the patient. CONCLUSIONS Despite fears of increased liability from the hospitalist model of care, hospitalists in internal medicine are subject to medical malpractice claims less frequently when compared to other internal medicine physicians and specialties. Journal of Hospital Medicine 2014;9:750–755. © 2014 Society of Hospital Medicine

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“…The number of years in practice (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and 21+ years) was included instead of age, as those two variables were highly correlated. Time spent in email or phone conversation with other physicians was included to measure each physician's level of communication.…”

Section: Methodsmentioning

confidence: 99%

“…3 Several studies have shown that successful hospitalist programs improved inpatient efficiency without harmful effects on quality. [4][5][6][7] Proponents contend that successful hospitalist programs have the potential to improve outpatient primary care physicians' (PCPs' ) productivity because hospitalists can reduce the need for PCPs to go to the hospital, allowing them to see more patients in the office than was previously possible. 3,[8][9][10] A major risk of hospitalist models is poor communication and the potential discontinuity between inpatient and outpatient care.…”

Section: Introductionmentioning

confidence: 99%

Use of Hospitalists and Office-Based Primary Care Physicians’ Productivity

Park

Jones

2014

J GEN INTERN MED

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BACKGROUND: Growth in the care of hospitalized patients by hospitalists has the potential to increase the productivity of office-based primary care physicians (PCPs) by allowing them to focus on outpatient practice. OBJECTIVE: Our aim was to examine the association between utilization of hospitalists and the productivity of office-based PCPs. DESIGN/PARTICIPANTS: The cross-sectional study was conducted using the 2008 Health Tracking Physician Survey Restricted Use File linked to the Area Resource File. We analyzed a total of 1,158 office-based PCPs representing a weighted total of 97,355 physicians. MAIN MEASURES: Utilization of hospitalists was defined as the percentage of a PCP's hospitalized patients treated by a hospitalist. The measures of PCPs' productivity were: (1) number of hospital visits per week, (2) number of office and outpatient clinic visits per week, and (3) direct patient care time per visit. KEY RESULTS: We found that the use of hospitalists was significantly associated with a decreased number of hospital visits. The use of hospitalists was also associated with an increased number of office visits, but this was only significant for high users. Physicians who used hospitalists for more than three-quarters of their hospitalized patients had an extra 8.8 office visits per week on average (p=0.05), which was equivalent to a 10 % increase in productivity over the predicted mean of 87 visits for physicians who did not use hospitalists. We did not find any significant differences in direct patient care time per visit. CONCLUSIONS: Our study demonstrates that the increase in productivity for the one-third of PCPs who use hospitalists extensively may not be sufficient to offset the current loss of PCP workforce. However, our findings provide cautious optimism that if more PCPs effectively and efficiently used hospitalists, this could help mitigate a PCP shortage and improve access to primary care services.KEY WORDS: hospitalists; primary care physician shortage; productivity.

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Outcomes of Care by Hospitalists, General Internists, and Family Physicians

Cited by 208 publications

References 29 publications

Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

Liability impact of the hospitalist model of care

Use of Hospitalists and Office-Based Primary Care Physicians’ Productivity

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