Adoption of Hospitalist Care in Asia: Experiences From Singapore, Taiwan, Korea, and Japan

Abstract

ince its inception in the mid-1990s, the hospitalist model of care has enjoyed robust growth in the United States, increasing to around 20,000 providers by the end of its first decade. 1,2 Since then, it has far outstripped early predictions of adoption, currently standing at more than 50,000 hospitalist providers. 2 Although driven by numerous factors, including system-based management needs, provision of inpatient care for unassigned patients, and demands for improved patient safety and satisfaction, this meteoric growth has been driven largely by cost pressures particular to the US healthcare system. 1,2 Nonetheless, the growing complexity of healthcare systems, substantial fiscal pressures, and increasing healthcare demands from aging populations are worldwide challenges to which countries outside North America also seek solutions. Countries that have initiated hospitalist care have localized adoption, evolving the model to meet their unique fiscal and system-based needs and patients' expectations.While there has been keen interest in the hospitalist model in Asia, there has not yet been widespread adoption, despite numerous data demonstrating that this model is associated with lower length of stay (LOS), as well as lower costs and improved patient safety. 3,4 This article explores hospitalist care adoption experiences in Singapore, Taiwan, Korea, and Japan, focusing on stakeholder demand for hospitalist-care, respective adoption, outcomes, and associated challenges to date.

Impact of the hospitalist system on inpatient mortality and length of hospital stay in a teaching hospital in Japan: a retrospective observational study

“…30 These Asian countries and Japan have the same issues regarding medical quality and patient safety. 10 In this study, we revealed the exact effects of the reduction of LOS.…”

“…7 Currently, HS have spread to other countries from the USA and have reached East Asian countries, including Singapore, Korea and Taiwan, which have demonstrated notable improvements in the quality of care. [8][9][10] For example, Korea introduced a HS into general medicine and surgery in 2016 to solve their problems such as patient safety, healthcare quality and residents' well-being. 11 12 The HS improved many clinically significant indicators about not only medical quality and safety but also patient satisfaction.…”

“…8 16 Regarding the length of hospital stay, Singapore, Korea and Taiwan have succeeded in reducing it by the HS. 10 The HS may be appropriate for the Japanese setting; however, whether it could function in Japan is still unclear. One report found that hospitalists and general physicians improved the quality of the treatment of two crucial common diseases (pneumonia and cerebral infarction) in a community hospital.…”

Roles considered important for hospitalist and non-hospitalist generalist practice in Japan: A survey study

“…Studies have shown that the presence of hospitalists in Japan has shortened hospital stays and reduced costs for common diseases such as pneumonia and heart failure [24][25][26]. Similarly, a report summarising the role of hospitalists in four Asian countries also emphasizes the importance of their role in addressing healthcare quality [5]. The results of these previous studies indicate that quality and safety of medical care is a core interest for Japanese hospitalists and that their work is improving patient care in this area.…”

“…Since its inception, the number of hospitalists has continued to grow, with current estimates of at least 44,000 adult hospitalists in the United States of America (USA) [3]. An interesting aspect of the rapid expansion of hospital medicine is the growth of the eld beyond the USA including Asian Countries [4,5,6]. While some of the reasons for the development of hospital medicine internationally are the same as in the United States, there are differences in training, health care systems, regulations, and cultural norms underscoring the practice of hospital medicine in different countries.…”