Objective Impact of Hematology-Oncology Hospitalist Care in an Inpatient Setting

Abstract

PURPOSE: The utilization of the hospitalist care model has increased over the past decade because of improved cost-effectiveness, quality of care, and value that it provides. Studies have shown that compared with the traditional care model, use of hospitalists provides cost-saving and improved value to hospital systems. However, the data for the use of oncology hospitalists (ONC Hosp) are sparse. In this study, we investigate the impact of inpatient ONC Hosp on 30-day readmissions, length of stay (LOS), discharge to hospice, and inpatient mortality when compared with a traditional model where outpatient oncologists manage the acute issues of hospitalized patients with cancer. METHODS: Rhode Island Hospital hired ONC Hosps to attend on the inpatient oncology service. To determine the impact of this new patient care model, we performed a retrospective review of oncology patients admitted to Rhode Island Hospital between July 1, 2012, and June 30, 2018, and compared quality outcomes of 30-day readmission, LOS, discharge to hospice, and inpatient mortality to those from the traditional care model. RESULTS: Compared with outpatient oncologists care, care by ONC Hosp was associated with a significant decrease in 30-day readmissions (23.0% v 29.6%, P = .019) and a significant increase in discharge to hospice (18.1% v 12.1%, P < .001). No significant difference was detected between LOS ( P = .833) or inpatient mortality ( P = .332). CONCLUSION: This study shows that compared with the traditional care model, the use of ONC Hosps has a positive impact on patient care and the potential to add value to the hospital system.

Oncology hospitalist impact on hospice utilization

“…This work demonstrated a significant increase in the combined outcome of discharge to inpatient and home hospice (12.1% vs. 18.1%; p < .001) among patients cared for by an oncology hospitalist compared with a rotating outpatient oncologist. 20 Our study demonstrates similar unadjusted combined inpatient and home hospice discharge rates of 10.6% (TS) and 16.6% (HS).…”

“…Only one published study evaluated the impact of oncology hospitalist involvement on inpatient hospice referrals, reporting outcomes before and after hospitalist integration on an inpatient medical oncology unit. This work demonstrated a significant increase in the combined outcome of discharge to inpatient and home hospice (12.1% vs. 18.1%; p < .001) among patients cared for by an oncology hospitalist compared with a rotating outpatient oncologist 20 . Our study demonstrates similar unadjusted combined inpatient and home hospice discharge rates of 10.6% (TS) and 16.6% (HS).…”

Outcomes on an inpatient oncology service after the introduction of hospitalist comanagement

“…9,14 A LOS reduction was seen with an increase in discharge volume in a community-based oncology hospitalist program 16 and a smaller academic center demonstrated a significant decrease in 30-day readmissions but no change in LOS with oncology hospitalists. 17 Overall, these studies conclude that hospitalist care is at least equivalent to rotating oncologist care.…”

“…The quality and efficiency of hospitalist care in both general inpatient medical units [5][6][7][8] and in subspecialty settings [9][10][11][12][13][14][15] has been well-established. Despite growth in dedicated oncology hospitalist programs at major cancer centers, [9][10][11][12]14,15 little has been published on key quality outcomes, including length of stay (LOS), early discharges, and 30-day readmission rates.…”

“…The quality and efficiency of hospitalist care in both general inpatient medical units [5][6][7][8] and in subspecialty settings [9][10][11][12][13][14][15] has been well-established. Despite growth in dedicated oncology hospitalist programs at major cancer centers, [9][10][11][12]14,15 little has been published on key quality outcomes, including length of stay (LOS), early discharges, and 30-day readmission rates. In this manuscript, through the implementation of a real-time, direct comparison between a oncologist-led, traditional service (TS) and a hospitalist service (HS), we assess the impact of a hospitalist-driven model on LOS, early discharge rate, and 30-day readmission rate on an inpatient oncology service.…”