Impact of Hospitalists on the Quality of Care of Acute Medical Conditions

1Institute for Health Policy and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, and Brigham and Women's Hospitalist Program and Department of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
2Harvard School of Public Health, Boston, MA
3Brigham and Women's Hospitalist Program and Department of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
4Brigham and Women's Hospitalist Program and Department of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
5Institute for Health Policy and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 46

Background:

Despite existing literature examining the effects of hospitalist care on inpatient hospital‐associated costs and experiences with care, little is known about the impact of hospitalists on performance as measured by the Hospital Quality Alliance (HQA) Inpatient Quality of Care Indicators.

Methods:

We used HQA data to measure hospital‐level quality of care for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia from October 2005 through September 2006. For each of the 3 conditions, we examined the quality of care for 3619 hospitals reporting data to the HQA. Only quality indicators related to hospitalist care were included. For each hospital, we created 2 additional composites representing the domains of (1) treatment and diagnosis and (2) counseling and prevention across conditions. Composite scores for each disease were created by dividing the number of times a hospital performed the appropriate care across all measures for that condition by the number of opportunities the hospital had to provide appropriate care for that condition. We linked data on hospital characteristics from the American Hospital Association. The chi‐square test was used to compare the characteristics of hospitals with and without hospitalists. We estimated a series of event‐trial logistic regression models to examine the relationship between hospitalists and overall quality of care for each condition, controlling for hospital characteristics. This method permitted the probability of a met opportunity to vary across hospitals.

Results:

Of 3619 hospitals, 1461 (40%) had hospitalists. Hospitals with hospitalists tended to be urban, large, private, not‐for‐profit, teaching hospitals in the Northeast. Hospitals without hospitalists tended to be rural, small, public/municipal, nonteaching hospitals in the Midwest. The mean overall composite scores were significantly higher for hospitals with hospitalists than for those with no hospitalists for all conditions (0.93 vs. 0.86 for AMI, 0.82 vs. 0.72 for CHF, and 0.75 vs. 0.71 for pneumonia, all P < .001). Hospitals with hospitalists also performed better than hospitals without hospitals for the dimensions of overall treatment and diagnosis (0.87 vs. 077) and for counseling and prevention (0.75 vs. 0.66), both P < .001. After multivariable adjustment, hospitals with hospitalists continued to perform significantly better than those without hospitalists across all composite scores except for CHF, where there was no significant difference (ORs ranging from 1.11 to 1.20).

Conclusions:

Hospitals with hospitalists were associated with better performance on HQA indicators for AMI and pneumonia and in the domains of overall disease treatment and diagnosis and counseling and prevention. The involvement of hospitalists in the acute care of hospitalized patients should be considered as a possible means to improve the quality of care delivered to patients with common inpatient diagnoses.

Author Disclosure:

L. Lopez, none; A. Cohen, none; L. Hicks, none; S. McKean, none; J. Weissman, none.

To cite this abstract:

Lopez L, Cohen A, Hicks L, McKean S, Weissman J. Impact of Hospitalists on the Quality of Care of Acute Medical Conditions. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 46. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/impact-of-hospitalists-on-the-quality-of-care-of-acute-medical-conditions/. Accessed May 26, 2019.

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