A review of 208 California hospitals shows the presence of hospitalists was associated with process improvements across three medical conditions—acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia—but the specific role HM played in those results remains murky, according to a study in this month’s Journal of Hospital Medicine.
The review, "Cross-Sectional Analysis of Hospitalist Prevalence and Quality of Care in California (PDF)” (2010;5(4);200-207), found that in the 170 subject hospitals with HM programs, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P<0.001) missed quality opportunities for AMI at admission. In addition, hospitalists were associated with 0.6% (P<0.001), 0.5% (P=0.004), and 1.5% (P=0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively.
“You can’t really see anything that’s causative, but … hospitals with hospitalists versus those who were without were definitely different,” says lead author Eduard Vasilevskis, MD, assistant professor of medicine in the Section of Hospital Medicine at Vanderbilt University and the Tennessee Valley-Nashville VA Hospital. “But it’s unclear if it’s the hospitalists themselves who are doing the improvements in quality initiatives, or is it more a hospital willing to invest in quality and hospitalists are part of that but there other investments going on?”
Dr. Vasilevskis’ team measured 16 publicly reported quality measures but could draw no conclusions as to HM’s direct role in the quality improvements. He suggests the next step in HM research will be to bridge the gap between defining the presence of hospitalists and qualitatively defining their impacts on respective institutions. Along that line, Dr. Vasilevskis notes that only 38 of the 208 hospitals in the review did not have HM programs, a trend that in time would eliminate the ability to study hospital performance without taking hospitalist care into account.
“Ten years from now, this study couldn’t be done any longer,” he says. “Given the evidence we know so far on length of stay, readmissions … that’s probably a good thing.”