Hospitalist utilization and hospital performance on 6 publicly reported patient outcomes

Authors

  • Kate Goodrich MD, MHS,

    Corresponding author
    1. Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, Maryland
    2. Division of Hospital Medicine, Department of Medicine, George Washington University School of Medicine, Washington, DC
    • Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, 7500 Security Blvd, S3-02-01, Baltimore, MD 21244
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    • Telephone: 410-786-6841; Fax: 410-786-6857

  • Harlan M. Krumholz MD, SM,

    1. Section of Health Policy and Administration, Yale School of Public Health, Center for Outcomes Research and Evaluation, Yale—New Haven Hospital, New Haven, Connecticut
    2. Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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  • Patrick H. Conway MD, MSc,

    1. Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, Maryland
    2. Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Peter Lindenauer MD, MSc,

    1. Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
    2. Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts
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  • Andrew D. Auerbach MD, MPH

    1. Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
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Abstract

BACKGROUND:

The increase in hospitalist-provided inpatient care may be accompanied by an expectation of improvement on patient outcomes. To date, the association between utilization of hospitalists and the publicly reported patient outcomes is unknown.

OBJECTIVE:

Assess the relationship between hospitalist utilization and performance on 6 publicly reported patient outcomes.

DESIGN:

Cross-sectional study.

PARTICIPANTS:

Representatives of 598 hospitals in the United States with direct knowledge of inpatient service models.

INTERVENTION:

Survey of hospital personnel with knowledge of hospitalist use and hospitalist programs.

MEASUREMENTS:

Six publicly reported quality outcome measures across 3 medical conditions: acute myocardial infarction (AMI), congestive heart failure (HF), and pneumonia. Using multivariable regression models, we assessed the relationship between presence of hospitalists and performance on each outcome measure; we further assessed the relationship between the percentage of patients admitted by hospitalists and each outcome measure.

RESULTS:

Of 598 respondents, 429 (72%) reported the use of hospitalist services. In the comparison of hospitals with and without hospitalists, there was no statistically significant difference on any of the mortality or readmissions measures with the exception of the risk-stratified readmission rate for heart failure. For hospitals that used hospitalists, there was no significant change in any of the outcome measures with increasing percentage of patients admitted by hospitalists.

CONCLUSIONS:

The presence of hospitalists is not an independent predictor of performance on publicly reported mortality and readmissions measures for AMI, HF, or pneumonia. It is likely that broader system or organizational interventions are required to improve performance on patient outcomes. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

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