Hospitalists modestly improve quality of care
Hospitalists, physicians specializing in inpatient care, represent a change in the organization of inpatient care that may improve hospital performance, suggests a new study. It found that California hospitals using hospitalists showed modest improvements in performance on publicly reported care process measures for heart attack, congestive heart failure (CHF), and pneumonia. For example, hospitals with at least one hospitalist group had fewer missed discharge care process measures for heart attack, such as a discharge prescription for an angiotensin converting enzyme inhibitor. Also, as the estimated percentage of patients admitted by hospitalists rose, the percentage of missed quality opportunities, such as pneumonia and influenza vaccination for patients with pneumonia, decreased across multiple measures.
However, the positive association between hospitalists and care quality processes was most typically found for processes that generally took place later in hospitalization or at discharge. Performance on admission measures would not be expected to relate to use of hospitalists, since they were more likely to be under the direction of emergency physicians. Of the 208 hospitals participating in this voluntary quality reporting initiative, 171 had hospitalists, of which 71 (42 percent) estimated the percentage of patients admitted by their hospitalist physicians. Included in the study were 16 publicly reported quality process measures across 3 medical conditions: heart attack, CHF, and pneumonia.
Hospitals with hospitalists were larger, less likely to be for-profit, had more registered nursing hours per day, and performed more cardiac catheterizations. The question of whether hospitalists directly improve care quality or simply reflect a hospital's level of investment in quality remains a subject for future study, note the University of California, San Francisco, researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS11416).
See "Cross-sectional analysis of hospitalist prevalence and quality of care in California," by Eduard E. Vailovskis, M.D., R. Justin Knebel, B.S., R. Adams Dudley, M.D., M.B.A., and others in the April 2010 Journal of Hospital Medicine 5(4), pp. 200-207.
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