Cross-sectional analysis of hospitalist prevalence and quality of care in California

Authors

  • Eduard E. Vasilevskis MD,

    Corresponding author
    1. Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
    2. Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
    3. Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee
    4. Geriatric Research Education and Clinical Care (GRECC), Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee
    5. Clinical Research Training Center of Excellence (CRCoE), Department of Veterans Affairs, Nashville, Tennessee
    6. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
    • Vanderbilt University Medical Center, 1215 21st Ave., S., 6006 Medical Center East, NT, Nashville, TN 37232-8300
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    • Telephone: 615-936-1935; Fax: 615-936-1269

  • R. Justin Knebel BS,

    1. Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
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  • R. Adams Dudley MD, MBA,

    1. Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, California
    2. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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  • Robert M. Wachter MD,

    1. Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
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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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  • Supported by a California Healthcare Foundation Grant (05-1755). During the course of this research, A.D.A. was also supported by a K08 research and training grant (K08 HS11416-02) from the Agency for Healthcare Research and Quality (AHRQ). R.A.D.'s work on this project was supported by an Investigator Award in Health Policy, Robert Wood Johnson Foundation. E.E.V. was supported by a Ruth L. Kirschstein National Research Service Award Institutional Research-Training Grant T32, the Veterans Affairs Clinical Research Center of Excellence, and the Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Veterans Affairs, Tennessee Valley Healthcare, Nashville, TN. The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs.

  • Disclosure: Nothing to report.

Abstract

BACKGROUND:

Hospital leaders usually provide financial support to hospitalists groups, often with an expectation of improved performance on publicly reported quality metrics. Whether the presence of hospitalists is associated with differences in hospital-level performance is unknown.

OBJECTIVE:

Assess the relationship between hospitalist prevalence and quality performance.

DESIGN:

Cross-sectional study.

PARTICIPANTS:

A total of 208 California hospitals participating in a voluntary reporting initiative.

INTERVENTION:

Survey of hospital personnel with knowledge of the utilization of hospitalists for patient care.

MEASUREMENTS:

Sixteen publicly reported quality process measures across 3 medical conditions: acute myocardial infarction (AMI); congestive heart failure (CHF); and pneumonia. Using multivariable models, we assessed the relationship between the presence of hospitalists and the percentage of missed quality opportunities for each process measure.

RESULTS:

Of 208 eligible hospitals, 170 (82%) had hospitalist services. After adjustment, hospitals with hospitalists had similar performance for cardiac and pneumonia measures assessed at admission and fewer missed processes for CHF measures assessed at discharge. Among sites with hospitalists, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P < 0.001) missed quality opportunities for AMI at admission, and 0.6% (P < 0.001), 0.5% (P = 0.004), and 1.5% (P = 0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively.

CONCLUSIONS:

The presence of hospitalists in California was associated with modest improvements in performance on publicly reported process measures. Whether hospitalists directly improve quality or simply reflect a hospital's level of investment in quality remains a subject for future study. Journal of Hospital Medicine 2010;5:200–207. © 2010 Society of Hospital Medicine.

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