The Hospitalist Movement 5 Years Later

Abstract

Empirical research supports the premise that hospitalists improve inpatient efficiency without harmful effects on quality or patient satisfaction. Education may be improved. In part catalyzed by these data, the clinical use of hospitalists is growing rapidly, and hospitalists are also assuming prominent roles as teachers, researchers, and quality leaders. The hospitalist field has now achieved many of the attributes of traditional medical specialties and seems destined to continue to grow.

Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

“…Although teaching team assignment appears random, because allocation is not concealed, we considered this a quasi-experimental design. 13,14 Eighteen hospitalist and 61 non-hospitalist faculty serve as ward teaching attending physicians, and are assigned to teaching teams in one-month blocks. Because we hypothesized that premature discharge might cause harm among patients under the care of short LOS physicians, we attributed each admission to the discharging attending physician, whom we assumed was the final arbiter of the decision to discharge.…”

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

“…Commonly, hospital-based physicians, including hospitalists, and medical and surgical residents in academic institutions, work exclusively in the hospital and care for the majority of hospitalized patients. [20][21][22][23][24][25][26] Oftentimes, the hospital physician is first introduced to their patient at hospital admission and must rely on the history, physical exam and medical record when making medical decisions. [27][28][29][30][31] For this reason, the hospital physician may be unaware of a patient's drug or alcohol use or mental illness, all risk factors for opioid misuse.…”

Use of Hospitalists and Office-Based Primary Care Physicians’ Productivity

“…The number of years in practice (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and 21+ years) was included instead of age, as those two variables were highly correlated. Time spent in email or phone conversation with other physicians was included to measure each physician's level of communication.…”

“…One widely discussed advantage is that hospitalists can contain hospital costs and improve inpatient efficiency. 3 Several studies have shown that successful hospitalist programs improved inpatient efficiency without harmful effects on quality. [4][5][6][7] Proponents contend that successful hospitalist programs have the potential to improve outpatient primary care physicians' (PCPs' ) productivity because hospitalists can reduce the need for PCPs to go to the hospital, allowing them to see more patients in the office than was previously possible.…”

“…[4][5][6][7] Proponents contend that successful hospitalist programs have the potential to improve outpatient primary care physicians' (PCPs' ) productivity because hospitalists can reduce the need for PCPs to go to the hospital, allowing them to see more patients in the office than was previously possible. 3,[8][9][10] A major risk of hospitalist models is poor communication and the potential discontinuity between inpatient and outpatient care. [11][12][13][14][15] A systematic review documented that communication between hospitalists and PCPs occurred infrequently (3-20 % of cases); the availability of a discharge summary at the first post discharge visit was low (12-34 %) and remained poor at 4 weeks (51-77 %); and poor communication affected the quality of care in approximately 25 % of follow-up visits.…”