The Hospitalist Model and Oncology: Oncologist Opinions About Inpatient Cancer Care Delivery

Atlas, Kathleen R.; Egan, Barbara; Novak, Caroline J.; Sidlow, Robert

doi:10.1634/theoncologist.2020-0514

Cited by 7 publications

(12 citation statements)

References 9 publications

(8 reference statements)

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“…The trend of dedicated inpatient physicians caring for hospitalized patients continues to grow, and studies investigating this care model have shown decreased lengths of stay, lower costs, and improved outcomes for certain patient populations. 2,3,[5][6][7][8][9][10] Changes in outcomes with the use of dedicated inpatient board-certified oncologists to supervise house staff teams caring for oncology patients has not been described in the literature to the best of our knowledge. Data from our institution show that ONC Hosp teams resulted in decreased 30-day readmission rates and increased rates of discharge to hospice with no significant difference in LOS or inpatient mortality.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…9 A survey of oncologists at a tertiary care center showed that a minority felt that attending on the inpatient service was an efficient use of their time and most felt that hospitalists could appropriately diagnose and manage toxicities related to cancer and cancer treatment. 10 At Rhode Island Hospital (RIH), the traditional care model consisted of rotating Outpt ONC overseeing the inpatient oncology service for 1-2 weeks at a time. In 2015, subspecialists who had completed oncology fellowship were hired as full-time hospitalists and a new model was created for the care of hospitalized patients with cancer.…”

Section: Introductionmentioning

confidence: 99%

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

Fanucci

Yang

Chambers

et al. 2022

JCO Oncology Practice

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Fanucci

Yang

Chambers

et al. 2022

JCO Oncology Practice

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“…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.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Morris

Rothberg

Prsic

et al. 2023

Journal of Hospital Medicine

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Background: Smilow Cancer Hospital (SCH) introduced hospitalist comanagement to the inpatient oncology service to address long lengths of stay and oncologist burnout.Objective: To determine the impact of hospitalists on inpatient quality outcomes and oncologist experience. Interventions: Hospitalists were introduced to one of two inpatient oncology services at SCH. Patients were assigned to teams equally based on capacity. Outcomes on the oncologist-led, traditional service (TS) were compared with outcomes on the hospitalist service (HS) 6 months after program implementation. Main Outcomes and Measures: Outcomes included patient volume, length of stay (LOS), early discharge, discharge time, and 30-day readmission rate. Mixed linear or Poisson models that accounted for multiple admissions during the study duration were used. Oncologist experience was measured by survey.Results: During the study period, there were 713 discharges, 400 from the HS and 313 from the TS (p = .0003). There was no difference in demographics or severity of illness (SOI) between services. Following adjustment for age, sex, race/ethnicity, cancer type, and discharge disposition, the average LOS was 4.71 on the HS and 5.47 on the TS (p = .01). Adjusted early discharge rate was 6.22% on the HS and 2.06% on the TS (p = .01). Adjusted mean discharge time was 3:45 p.m. on HS and 4:16 p.m. on TS (p = .009). There was no difference in readmission rates. Oncologists reported less stress (p = .001) and a better ability to manage competing responsibilities (p < .0001) while working on the HS.Conclusions: Hospitalist comanagement significantly improved LOS, early discharge, time of discharge, and oncologist experience without an increase in 30-day readmissions.

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Oncology hospitalist impact on hospice utilization

Prsic,

Morris,

Adelson

et al. 2023

Cancer

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BackgroundUnplanned hospitalizations among patients with advanced cancer are often sentinel events prompting goals of care discussions and hospice transitions. Late referrals to hospice, especially those at the end of life, are associated with decreased quality of life and higher total health care costs. Inpatient management of patients with solid tumor malignancies is increasingly shifting from oncologists to oncology hospitalists. However, little is known about the impact of oncology hospitalists on the timing of transition to hospice.ObjectiveTo compare hospice discharge rate and time to hospice discharge on an inpatient oncology service led by internal medicine‐trained hospitalists and a service led by oncologists.MethodsAt Smilow Cancer Hospital, internal medicine‐trained hospitalists were integrated into one of two inpatient medical oncology services allowing comparison between the new, hospitalist‐led service (HS) and the traditional, oncologist‐led service (TS). Discharges from July 26, 2021, through January 31, 2022, were identified from the electronic medical record. The odds ratio for discharge disposition by team was calculated by logistic regression using a multinomial distribution. Adjusted length of stay before discharge was assessed using multivariable linear regression.ResultsThe HS discharged 47/400 (11.8%) patients to inpatient hospice, whereas the TS service discharged 18/313 (5.8%), yielding an adjusted odds ratio of 1.94 (95% CI, 1.07–3.51; p = .03). Adjusted average length of stay before inpatient hospice disposition was 6.83 days (95% CI, 4.22–11.06) for the HS and 16.29 days (95% CI, 7.73–34.29) for the TS (p = .003).ConclusionsOncology hospitalists improve hospice utilization and time to inpatient hospice referral on an inpatient medical oncology service.Plain Language Summary Patients with advanced cancer are often admitted to the hospital near the end of life. These patients generally have a poor chance of long‐term survival and may prefer comfort‐focused care with hospice. In this study, oncology hospitalists discharged a higher proportion of patients to inpatient hospice with less time spent in the hospital before discharge.

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The Hospitalist Model and Oncology: Oncologist Opinions About Inpatient Cancer Care Delivery

Cited by 7 publications

References 9 publications

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

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

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

Oncology hospitalist impact on hospice utilization

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