title: Associations between use of the hospitalist model and quality of care and outcomes of older patients hospitalized for heart failure.
abstract: OBJECTIVE
  This study sought to examine the associations of hospitalist and cardiologist care of patients with heart failure with outcomes and adherence to quality measures.
  
  
  BACKGROUND
  The hospitalist model of inpatient care has grown nationally, but its associations with quality of care and outcomes of patients hospitalized with heart failure are not known.
  
  
  METHODS
  We analyzed data from the Get With the Guidelines-Heart Failure registry linked to Medicare claims for 2005 through 2008. For each hospital, we calculated the percentage of heart failure hospitalizations for which a hospitalist was the attending physician. We examined outcomes and care quality for patients stratified by rates of hospitalist use. Using multivariable models, we estimated associations between hospital-level use of hospitalists and cardiologists and 30-day risk-adjusted outcomes and adherence to measures of quality care.
  
  
  RESULTS
  The analysis included 31,505 Medicare beneficiaries in 166 hospitals. Across hospitals, the use of hospitalists varied from 0% to 83%. After multivariable adjustment, a 10% increase in the use of hospitalists was associated with a slight increase in mortality (risk ratio: 1.03; 95% confidence interval [CI]: 1.00 to 1.06) and decrease in length of stay (0.09 days; 95% CI: 0.02 to 0.16). There was no association with 30-day readmission. Increased use of hospitalists in hospitals with high use of cardiologists was associated with improved defect-free adherence to a composite of heart failure performance measures (risk ratio: 1.03; 95% CI: 1.01 to 1.06).
  
  
  CONCLUSIONS
  Hospitalist care varied significantly across hospitals for heart failure admissions and was not associated with improved 30-day outcomes. Comanagement by hospitalists and cardiologists may help to improve adherence to some quality measures, but it remains unclear what care model improves 30-day clinical outcomes.
authors.affiliation: CardioVascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: rkociol@bidmc.harvard.edu.
authors.forename: Robb D
authors.initials: RD
authors.lastname: Kociol
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Division of Cardiology, Department of Medicine, Palo Alto Veterans Affairs Medical Center, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Epidemiology and Biostatistics and Medicine, University of California, San Francisco.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: CardioVascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: CardioVascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: CardioVascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D020445:Hospitalists; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D008962:Models, Theoretical; D063868:Patient Outcome Assessment; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States
keywords: Medicare; heart failure; hospitalists; outcome assessment (health care)