Hospitalization

Improving communication with patients needs to be major focus for hospitalist systems

There is a trend for hospitals to use hospitalists—a dedicated group of specialists in inpatient medicine—in place of a patient's outpatient or primary care doctor to manage care while the patient is hospitalized. Removing primary care doctors from direct involvement in inpatient care may be more efficient, but its impact on patients' experiences in the hospital remains unknown. A recent study, supported in part by the Agency for Health Care Policy and Research (HS06452), cautions that this approach requires increased attention to patient education and physician-patient communication.

The study was conducted at Brigham and Women's Hospital, which, at the time of the study, did not have a designated hospitalist system. The researchers found that patients hospitalized with chest pain whose regular physicians remained involved in their hospital care were less likely than patients managed by a physician other than their regular doctor to report communication problems regarding tests (20 percent vs. 31 percent), activity after discharge (42 percent vs. 51 percent), and health habits (31 percent vs. 38 percent). Communication about test results and their meaning, what activities to do or not to do after discharge, and how to change health habits such as smoking or diet plays an important role in improved patient care and health outcomes.

Regular physicians may communicate better with their patients in the hospital because they already know their patients well, and because they are personally responsible for coordinating postdischarge care, explain the study's lead author, Steven R. Simon, M.D., M.P.H., and principal investigator, Thomas H. Lee, M.D., M.Sc., of Harvard Medical School. Nevertheless, the authors point out that communication problems are common even among patients cared for by their own doctors. Formal hospitalist systems may offer opportunities to improve communication for all patients.

The researchers surveyed 1,059 consecutive patients hospitalized with chest pain from July 1990 to February 1992. They asked about demographic, clinical, and illness data and interviewed the patients by telephone 1 month after discharge.

For more details, see "Communication problems for patients hospitalized with chest pain," by Drs. Simon and Lee, Lee Goldman, M.D., M.P.H., and others, in the December 1998 Journal of General Internal Medicine 13, pp. 836-838.

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