Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures.
BMC Med. 2011 May 18;9(1):58
Authors: White HL, Glazier RH
ABSTRACT: BACKGROUND: : Despite more than a decade of research on hospitalists and their performance, disagreement still exists as to whether and how hospital-based physicians improve the quality of impatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians maintaining hospital privileges with concurrent outpatient practices. METHOD: S: Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, EMBASE, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attendings were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarizing according to their percent change, direction and statistical significance. RESULTS: : The majority of reviewed articles demonstrated that hospitalists were efficient providers of inpatient care observed by reductions in the average lengths of stay (69%) and total hospital costs (70%) of their patients ; however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and have not improved over time. Persistent issues include insufficient reporting of source/sample populations (n = 30), losses to follow-up (n = 42) and estimates of effect/random variability (n = 35); inappropriate use of statistical tests (n = 55) and failing to adjust for established confounders (n = 37). CONCLUSIONS: : Future research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups and the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality.
PMID: 21592322 [PubMed - as supplied by publisher]