Establishing a pediatric hospitalist program at an Academic Medical Center.
Academic medical centers have been challenged to respond to a rapidly changing and increasingly competitive health care environment. The Pediatric Consultation and Referral Service (PCRS) at Rainbow Babies & Children's Hospital (RB&C)/University Hospitals of Cleveland was established in 1993 with the goal of providing rapid access to community-based physicians for the referral of patients requiring urgent hospitalization within the broad scope of general pediatrics. We describe our initial 3-year experience in the planning, implementation, and evaluation of a pediatric hospitalist program. PCRS provided care to 2,740 patients during the first 3 years of operation, 63% (1,716) of whom were under age 3 years. Leading primary diagnoses in order of decreasing frequency were asthma, pneumonia, bronchiolitis, febrile illness, gastroenteritis, seizures, croup, apnea, and cellulitis. Third-party payer mix was: Medicaid 42%, managed care 42%, indemnity insurance 10%, self-pay 6%, and Bureau for Children with Medical Handicaps 1%. From survey data, referring physicians and pediatric residents assessed perceptions of access, collegiality, and quality of care in a highly favorable manner. Subspecialty colleagues perceived access and collegiality very favorably but rated quality of care substantially lower than referring physicians and residents did. Our experience demonstrates that a pediatric hospitalist program is logistically and economically feasible and may contribute to the patient care, education, and research missions of academic medical centers. A well-structured program can provide community physicians with excellent access and support collegial relationships. Beyond increasing a medical center's patient referral base, a hospitalist program can potentially enhance the esteem of the discipline of general pediatrics and, it is hoped, promote general pediatrics as a viable career option for trainees.
Ponitz
K
K
Department of Pediatrics, Rainbow Babies & Childrens Hospital, Case Western Reserve University, Cleveland, Ohio 44106-6019, USA.
Mortimer
J
J
Berman
B
B
D000046:Academic Medical Centers; D002648:Child; D002675:Child, Preschool; D006297:Health Services Accessibility; D006302:Health Services Research; D020445:Hospitalists; D006801:Humans; D007223:Infant; D009820:Ohio; D010372:Pediatrics / Q000458:organization & administration*; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000458:organization & administration*