Hospitalist utilization and hospital performance on 6 publicly reported patient outcomes.
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.


METHODS
Cross-sectional study.


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


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


METHODS
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.
Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, Maryland 21244, USA. kate.goodrich@cms.hhs.gov
Kate
K
Goodrich
Harlan M
HM
Krumholz
Patrick H
PH
Conway
Peter
P
Lindenauer
Andrew D
AD
Auerbach
D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D020445:Hospitalists / Q000706:statistics & numerical data* / Q000639:trends; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D006278:Medicare / Q000592:standards / Q000706:statistics & numerical data; D009026:Mortality / Q000639:trends*; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000401:mortality / Q000628:therapy; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D014481:United States