Staff-Only Pediatric Hospitalist Care of Patients With Medically Complex Subspecialty Conditions in a Major Teaching Hospital

Abstract

Compared with the subspecialist faculty/housestaff system, the staff-only pediatric hospitalist system was associated with a marked reduction in cost and length of stay for patients with medically complex subspecialty diseases. In this era of resident duty-hour restrictions and medical complexity of conditions in inpatients, staff-only hospitalist programs may have a vital role in pediatric teaching hospitals.

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

“…All studies showed lower costs of care for patients treated by academic hospitalists compared to those treated by community-based physicians ( n = 7), and 63% of investigations showed similar cost reductions between nonacademic hospitalists and traditional academic attending physicians (seven of eleven studies). Three evaluations reporting lower costs by hospitalists added length of stay as a covariate to their regression analyses [55,79,80]. In doing so, cost savings were no longer significant, suggesting that reductions in cost are likely the result of shorter length of stay as opposed to a reduction in the type and intensity of services provided, a finding supported by our previous analysis of process indicators which showed no reductions in the utilization of ancillary services by hospitalists.…”

“…Six authors reported declines in readmissions within 30 days of discharge [24,44,58,87,88]; however, only two were from risk-adjusted regression models [87,88] and one author failed to disclose the statistical significance of the relationship [44]. In addition, three studies reported higher readmissions among hospitalists, all of which involved comparisons to traditional academic attending physicians [59,79,80]. …”

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

“…All studies showed lower costs of care for patients treated by academic hospitalists compared to those treated by community-based physicians ( n = 7), and 63% of investigations showed similar cost reductions between nonacademic hospitalists and traditional academic attending physicians (seven of eleven studies). Three evaluations reporting lower costs by hospitalists added length of stay as a covariate to their regression analyses [55,79,80]. In doing so, cost savings were no longer significant, suggesting that reductions in cost are likely the result of shorter length of stay as opposed to a reduction in the type and intensity of services provided, a finding supported by our previous analysis of process indicators which showed no reductions in the utilization of ancillary services by hospitalists.…”

“…Six authors reported declines in readmissions within 30 days of discharge [24,44,58,87,88]; however, only two were from risk-adjusted regression models [87,88] and one author failed to disclose the statistical significance of the relationship [44]. In addition, three studies reported higher readmissions among hospitalists, all of which involved comparisons to traditional academic attending physicians [59,79,80]. …”

“GAPPS” in Patient Safety

“…A previous single-center study revealed that a staff-only model for care of children who are medically complex had lower costs and length of stay than a teaching service in which similar children were admitted. 15 Presumably, the lower costs seen in this study were driven, at least in part, by more efficient, less interventional care. Authors of a larger national database study evaluated staff-only visits versus supervised resident-staff emergency department visits.…”

Pediatric hospitalist systems versus traditional models of care: Effect on quality and cost outcomes

“…When studying readmission rate, Bellet and Whitaker 13 reported a statistically significant lower rate of readmission for a traditionally staffed service versus the hospitalist service (1% vs 3%; P ¼ 0.006). In contrast, Bekmezian et al 18 found a lower readmission rate for the hospitalist service (4.4% vs 0%; P ¼ 0.02). The studies by Dwight et al, 12 Landrigan et al, 14 Ogershok et al, 16 and Boyd et al 21 did not detect differences in readmission rates.…”

“…Readmission rate were reported by 6 studies. Bellet and Whitaker 13 found a higher readmission rate for pediatric hospitalists, Bekmezian et al 18 found a lower rate but on a subspecialty service. The study with the greatest power for this analysis, by Landrigan et al…”

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

“…All studies showed lower costs of care for patients treated by academic hospitalists compared to those treated by community-based physicians ( n = 7), and 63% of investigations showed similar cost reductions between nonacademic hospitalists and traditional academic attending physicians (seven of eleven studies). Three evaluations reporting lower costs by hospitalists added length of stay as a covariate to their regression analyses [55,79,80]. In doing so, cost savings were no longer significant, suggesting that reductions in cost are likely the result of shorter length of stay as opposed to a reduction in the type and intensity of services provided, a finding supported by our previous analysis of process indicators which showed no reductions in the utilization of ancillary services by hospitalists.…”

“…Six authors reported declines in readmissions within 30 days of discharge [24,44,58,87,88]; however, only two were from risk-adjusted regression models [87,88] and one author failed to disclose the statistical significance of the relationship [44]. In addition, three studies reported higher readmissions among hospitalists, all of which involved comparisons to traditional academic attending physicians [59,79,80]. …”

“GAPPS” in Patient Safety

“…A previous single-center study revealed that a staff-only model for care of children who are medically complex had lower costs and length of stay than a teaching service in which similar children were admitted. 15 Presumably, the lower costs seen in this study were driven, at least in part, by more efficient, less interventional care. Authors of a larger national database study evaluated staff-only visits versus supervised resident-staff emergency department visits.…”

Pediatric hospitalist systems versus traditional models of care: Effect on quality and cost outcomes

“…When studying readmission rate, Bellet and Whitaker 13 reported a statistically significant lower rate of readmission for a traditionally staffed service versus the hospitalist service (1% vs 3%; P ¼ 0.006). In contrast, Bekmezian et al 18 found a lower readmission rate for the hospitalist service (4.4% vs 0%; P ¼ 0.02). The studies by Dwight et al, 12 Landrigan et al, 14 Ogershok et al, 16 and Boyd et al 21 did not detect differences in readmission rates.…”

“…Readmission rate were reported by 6 studies. Bellet and Whitaker 13 found a higher readmission rate for pediatric hospitalists, Bekmezian et al 18 found a lower rate but on a subspecialty service. The study with the greatest power for this analysis, by Landrigan et al…”

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

“…All studies showed lower costs of care for patients treated by academic hospitalists compared to those treated by community-based physicians ( n = 7), and 63% of investigations showed similar cost reductions between nonacademic hospitalists and traditional academic attending physicians (seven of eleven studies). Three evaluations reporting lower costs by hospitalists added length of stay as a covariate to their regression analyses [55,79,80]. In doing so, cost savings were no longer significant, suggesting that reductions in cost are likely the result of shorter length of stay as opposed to a reduction in the type and intensity of services provided, a finding supported by our previous analysis of process indicators which showed no reductions in the utilization of ancillary services by hospitalists.…”

“…Six authors reported declines in readmissions within 30 days of discharge [24,44,58,87,88]; however, only two were from risk-adjusted regression models [87,88] and one author failed to disclose the statistical significance of the relationship [44]. In addition, three studies reported higher readmissions among hospitalists, all of which involved comparisons to traditional academic attending physicians [59,79,80]. …”

“GAPPS” in Patient Safety

“…A previous single-center study revealed that a staff-only model for care of children who are medically complex had lower costs and length of stay than a teaching service in which similar children were admitted. 15 Presumably, the lower costs seen in this study were driven, at least in part, by more efficient, less interventional care. Authors of a larger national database study evaluated staff-only visits versus supervised resident-staff emergency department visits.…”

Pediatric hospitalist systems versus traditional models of care: Effect on quality and cost outcomes

“…When studying readmission rate, Bellet and Whitaker 13 reported a statistically significant lower rate of readmission for a traditionally staffed service versus the hospitalist service (1% vs 3%; P ¼ 0.006). In contrast, Bekmezian et al 18 found a lower readmission rate for the hospitalist service (4.4% vs 0%; P ¼ 0.02). The studies by Dwight et al, 12 Landrigan et al, 14 Ogershok et al, 16 and Boyd et al 21 did not detect differences in readmission rates.…”

“…Readmission rate were reported by 6 studies. Bellet and Whitaker 13 found a higher readmission rate for pediatric hospitalists, Bekmezian et al 18 found a lower rate but on a subspecialty service. The study with the greatest power for this analysis, by Landrigan et al…”