The Impact of Hospitalists on the Cost and Quality of Inpatient Care in the United States: A Research Synthesis

Abstract

There is substantial disagreement regarding the impact of hospitalists on costs, quality, and satisfaction with inpatient care. The authors reviewed 21 evaluations of the use of hospitalists in U.S. hospitals. Most evaluations found that patients managed by hospitalists had lower total costs or charges than patients in comparison groups and that these savings were achieved primarily by reducing length of stay. Most evaluations found no statistically significant differences in quality of care or satisfaction. However, lack of random assignment limits the ability to draw causal inferences from many of the evaluations. All randomized studies were conducted in teaching hospitals, raising questions as to the generalizability of findings to nonteaching hospitals. Further research is needed to better identify the mechanisms by which hospitalists reduce length of stay and to ascertain which types of hospitalist programs are most effective and which patients are most likely to benefit.

Pediatric hospitalist systems versus traditional models of care: Effect on quality and cost outcomes

“…4 Over the last decade, data supporting the role of hospitalists in improving quality of care for adult patients has continued to accumulate. [5][6][7][8] A 2007 retrospective cohort study by Lindenaur et al 7 included nearly 77,000 adult patients and found small reductions in length of stay without adverse effects on mortality or readmission rates, and a 2009 systematic review by Peterson 6 included 33 studies and concluded that ''in general . .…”

Era of hospitalists

“…In an assessment of hospitalists in US hospitals, Coffman and Rundall [17] concluded that patients managed by hospitalists had lower total costs due to reductions in the length of stay, rather than improvements in the quality of care or satisfaction in comparison to other groups. These findings are also confirmed by a systematic review by White and Glazier [18] concluding that hospitalists are effectual providers of inpatient care, by decreasing the length of stay (69%), and overall hospital expenses (70%), but continue to have questionable quality of care compared to that of their contemporaries.…”

Non–housestaff medicine services in academic centers: Models and challenges

“…Their involvement in patient care may produce reductions in length of stay, greater efficiency in discharge planning, and significant cost savings. [35][36][37] Hospitalists may also improve throughput in emergency departments and decrease wait times, leading to more efficient bed utilization. 38 This leads to a potential for greater hospital revenue by increasing both the number of admissions, particularly surgical cases, and staffed inpatient beds, the latter a premium, as AMCs continue to expand their bed capacity almost annually.…”