Quality of care for decompensated heart failure: comparable performance between academic hospitalists and non-hospitalists.
BACKGROUND
Hospitalists improve efficiency, but little information exists regarding whether they impact quality of care.


OBJECTIVE
To determine hospitalists' effect on the quality of acute congestive heart failure care.


METHODS
Using data from the Multicenter Hospitalist Study, we retrospectively evaluated quality of care in patients admitted with congestive heart failure who were assigned to hospitalists (n = 120) or non-hospitalists (n = 252) among six academic hospitals.


METHODS
Quality measures included the percentage of patients who had ejection fraction (EF) measurement, received appropriate medications [i.e., angiotensin-converting enzyme inhibitor (ACE-I) or beta-blockers] at discharge, measures of care coordination (e.g., follow-up within 30 days), testing for cardiac ischemia (e.g., cardiac catheterization), as well as hospital length of stay, cost, and combined 30-day readmissions and mortality.


RESULTS
Compared to non-hospitalist physicians, hospitalists' patients had similar rates of EF measurement (85.3% vs. 87.5%; P = 0.57), ACE-I (91.5% vs. 88.0%; P = 0.52), or beta-blocker (46.9% vs. 42.1%; P = 0.57) prescriptions. Multivariable adjustment did not change these findings. Hospitalists' patients had higher odds of 30-day follow-up (adjusted OR = 1.83, 95% CI, 1.44 - 2.93). There were no significant differences between the groups' frequency of cardiac testing, length of stay, costs, or risk for readmission or death by 30-days.


CONCLUSIONS
Academic hospitalists and non-hospitalists provide similar quality of care for heart failure patients, although hospitalists are paying more attention to longitudinal care. Future efforts to improve quality of care in decompensated heart failure may require attention towards system-level factors.
Vasilevskis
Eduard E
EE
Division of Hospital Medicine, University of California San Francisco, San Francisco, CA 94143, USA. Eduard.Vasilevskis@ucsf.edu
Meltzer
David
D
Schnipper
Jeffrey
J
Kaboli
Peter
P
Wetterneck
Tosha
T
Gonzales
David
D
Arora
Vineet
V
Zhang
James
J
Auerbach
Andrew D
AD
D000046:Academic Medical Centers; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D020445:Hospitalists; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D013318:Stroke Volume