Hospitalists improve efficiency, but their effect on quality of care is not well characterized. We analyzed data from a sample of California hospitals to assess the relationship between prevalence of hospitalists and the frequency of missed quality measures at hospital discharge.
Between 2006 and 2007 we identified which of the 326 nonfederal general acute‐care hospitals in California (n = 326) had hospitalist services by: (1) phone, e‐mail, and fax surveys of hospital administrators (eg, chief medical officer); (2) phone, e‐mail, and fax surveys of hospitalist leaders already identified; (3) confirmation from emergency room admitting physicians or medical staff offices; or (4) the hospital's Web site. We then linked hospitalist prevalence data with quality data from 191 hospitals participating in the California Hospital Assessment and Reporting Taskforce (CHART). Using CHART data, we confirmed the frequency of missed quality measures at hospital discharge for 3 medical conditions: (1) acute myocardial infarction (AMI), (2) congestive heart failure (CHF), and (3) pneumonia. We then built regression models assessing the relationship between hospitalist prevalence and the frequency of missed quality measures using generalized linear models, adjusting for hospital characteristics (eg, bed size, ownership, teaching status, patient census) as well as patient‐mix factors (eg, case mix index and annual percentage of admissions by race, age, payer, and do‐not‐resuscitate status). Because the outcome measure distribution was right skewed, models employed Gaussian distributions with log‐link functions. We report results as the percent difference in missed quality measures; thus, a negative difference would correspond to the percentage of fewer measures missed by hospitals with hospitalists compared to those without.
Sixty‐nine percent (n = 226) of all hospitals had a hospitalist service. Eight‐three percent (n = 159) of the 191 hospitals participating in CHART had hospitalists. Regression models suggested that hospitals with hospitalists had fewer missed quality measures (higher quality) for care of acute myo‐cardial infarction or congestive heart failure, but similar quality in the care of pneumonia patients (see Table 1).
Table 1. Adjusted Percent Difference in Missed Quality Measures Among Hospitals with Hospitalists (n = 191)
California hospitals with hospitalist physicians demonstrated fewer missed quality measures among standard cardiac process measures. Our results suggest the benefits of hospitalists may extend beyond efficiency. Prospective data are needed to further confirm these observations.
E. Vasilevskis, none; R. Knebel, none; A. Auerbach, none; R. Dudley, none; R. Wachter, Google Health, Scientific Advisory Board Member; Intellidot, Scientific Advisory Board Member; Codigy, Scientific Advisory Board Member; Hoana Medical, Scientific Advisory Board Member; American Board of Internal Medicine, Member of the Board of Directors.
To cite this abstract:Vasilevskis E, Knebel R, Wachter R, Dudley R, Auerbach A. Relationship between Hospitalist Prevalence and Quality Performance among California Hospitals. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 80. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/relationship-between-hospitalist-prevalence-and-quality-performance-among-california-hospitals/. Accessed September 17, 2019.