The Value of a Hospitalist Service

Hackner, Dani; Tu, George; Braunstein, Glenn D.; Ault, Mark J.; Weingarten, Scott; Mohsenifar, Zab

doi:10.1378/chest.119.2.580

Cited by 60 publications

(9 citation statements)

References 16 publications

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“…13 Benefits in cost and LOS reductions may be, in part, due to the hospitalist nature of the model as hospital medicine literature has demonstrated similar reductions for Medicare patients of approximately $1000 and 0.5 days per admission. 8,9 Our findings support this hypothesis as the LOS reduction was not present during the first year of our MACE service during which the hospitalist model was not fully implemented. During this transition phase from the unitbased ACE to the mobile ACE service, there were 4 physicians who covered more than 75% of on-service time (10 of the 13 annual 4-week rotations), while the remaining 25% was covered by 3 physicians (each working 1 block).…”

Section: Discussionsupporting

confidence: 63%

“…While patients were very well-matched through propensity scoring and had identical DRG and DRG-SOI levels (the latter having been demonstrated in a previous study's regression analysis to be the leading correlate of LOS and cost), 9 there may be unaccounted for differences between the patients cared for on the MACE and in the control group. A third limitation is the external validity of our study, which took place in a single large academic medical center in New York City.…”

Section: Discussionmentioning

confidence: 97%

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Operational and quality outcomes of a mobile acute care for the elderly service

Farber

Korc-Grodzicki

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:The traditional acute care for the elderly (ACE) unit has demonstrated improved functional outcomes without increased costs or changes in length of stay (LOS). It is, however, limited in scope to patients cared for on a fixed geographical unit.OBJECTIVE:To compare operational and quality outcomes for patients cared for on a mobile ACE (MACE) service to those cared for on a unit‐based ACE service and matched controls on other general medical services.DESIGN:Retrospective cohort study with propensity‐score matching.SETTING:An urban academic medical center.PATIENTS:A total of 8094 hospitalized adults >64 years old admitted to an ACE, MACE, and general medical services from July 2006 to June 2009.INTERVENTION:An interdisciplinary MACE service com‐ posed of a geriatrician‐hospitalist, fellow, nurse coordinator, and social worker.MEASUREMENTS:LOS, total cost, 7‐ and 30‐day readmission rates, and in‐hospital mortality.RESULTS:Mean LOS and total cost were significantly lower for patients in the MACE service compared with the ACE unit service (5.8 vs 7.9 days, P < 0.001, and $10,315 vs $13,187, P = 0.002) and compared with propensity‐score matched controls during the second year of operation (5.6 vs 7.2 days, P < 0.001, and $10,693 vs $15,636, P < 0.001). In‐hospital mortality and 7‐ and 30‐day readmission rates were similar in all groups.CONCLUSIONS:A mobile ACE service may result in reduced LOS and lower costs with no change in in‐hospital mortality or 7‐ or 30‐day readmission rates when compared with standard medical service and a traditional unit‐based ACE service. Journal of Hospital Medicine 2011;6:358–363. © 2011 Society of Hospital Medicine

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 97%

Operational and quality outcomes of a mobile acute care for the elderly service

Farber

Korc-Grodzicki

et al. 2011

Journal of Hospital Medicine

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“…Only two of nine studies found significant declines (22%) in subspecialty consultation rates [67,68], one of which was based on unadjusted analyses [68]. None of the reviewed articles described improvements in ICU use ( n = 6), and one article described increased use of ICUs by hospitalists for patients with advanced stage lung cancer during these patients' final hospitalization [9].…”

Section: Resultsmentioning

confidence: 99%

Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

White

Glazier

2011

BMC Med

110

104

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BackgroundDespite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices.MethodsArticles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance.ResultsThe majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37).ConclusionsFuture research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality.

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“…En cuanto a la compatibilidad en la mejoría de la calidad asistencial y de la docencia clínica, Hackner et al destacaron el rol del hospitalista en la disminución de días de hospitalización y costos, no sólo en hospitales comunitarios sino que también en hospitales universitarios 12 .…”

Section: Demostrando Impactounclassified