Many speakers at the recent SHM annual meeting in Dallas focused on the many ways hospitalists enhance quality of care. The teamwork necessary to effectively render inpatient services was an especially important topic.
Hospitalists have compiled a significant amount of descriptive material about their working environments and the composition and workloads of hospitalist teams. However, there is not much material available quantifying the ways that various disciplines impact the overall care-delivery metrics of multidisciplinary hospitalist teams.
The SHM Non-Physician Provider Committee is interested in collecting information on multidisciplinary programs, their component disciplines and individual providers to help identify and describe teams that have integrated nurse practitioners, physician assistants, clinical pharmacists and pharmacologists, nurse clinical care coordinators, and other related disciplines into their practices. Our goal is to develop descriptions of successful and unsuccessful implementation models.
We would also like to collect information measuring additional domains of interest to major stakeholders. Such domains might include the clinical utilization of non-physician providers in relationship to both scope-of-practice and delegation of authority, the influence of multidisciplinary integration on patient-centered care and patient satisfaction, process and outcomes quality metrics, throughput and efficiency measures, documentation practices, hospital privileges for non-physicians, medical education in the multidisciplinary environment, risk management and, of course, reimbursement.
One might ask why the collection and analysis of such data should be of interest to hospitalists and to SHM. There are several immediate answers:
- The first reason involves manpower. Hospital medicine has become a growing discipline for physicians—one that did not exist on the radar screens of physician planners 10 years ago. However, given the growing demand for hospitalists there may be a significant shortage. To address this deficit, hospital medicine practices will need to attract new associates in the form of nurse practitioners and physician assistants. It is therefore imperative that hospitalists proactively identify barriers to the integration of non-physician providers into their practices and have successful implementation models to guide this effort.
- The second reason centers on the fact that hospitalists will continue to lead efforts to enhance quality of care. Incorporating a multidisciplinary approach—whether through the pre-rounding and follow-up of nurse clinical care coordinators, the counsel of clinical pharmacists, or the hands-on care of other disciplines—will facilitate throughput and improve quality as well as enhance patient satisfaction and communication. Identifying best practices in these particular domains will provide information crucial to success in these areas.
- The third reason is related to the cost of services. With declining reimbursements coupled with increasing costs, hospital medicine programs must identify and implement measures aimed at expense control and maximization of services. Used appropriately, non-physician providers provide a lower-cost alternative to a physician-only model. When one-to-one pairing occurs, physician/NPP team-care can be delivered in a parallel-versus-linear fashion, thus allowing for increased census as well as expedition of care.
The future of hospital medicine is one of continued growth with the demand for hospital medicine physicians far outstripping the available supply to meet the ever-increasing needs. SHM is committed to researching and sharing best practices, and views the use of multidisciplinary teams as an important model of care. Together, we can all achieve more.