Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Summary for Patients    Summary for Patients (PDF)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Auerbach, A. D.    Goldman, L.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

Implementation of a Voluntary Hospitalist Service at a Community Teaching Hospital: Improved Clinical Efficiency and Patient Outcomes

Andrew D. Auerbach, MD, MPH; Robert M. Wachter, MD; Patricia Katz, PhD; Jonathan Showstack, PhD, MPH; Robert B. Baron, MD, MS; and Lee Goldman, MD, MPH

3 December 2002 | Volume 137 Issue 11 | Pages 859-865

Background: Previous investigations of the effect of the hospitalist model on resource use and patient outcomes have focused on academic medical centers or have used short follow-up periods.

Objective: To determine the effects of hospitalist care on resource use and patient outcomes and whether these effects change over time.

Design: Retrospective cohort study.

Setting: Community-based, urban teaching hospital.

Patients: 5308 patients cared for by community or hospitalist physicians in the 2 years after implementation of a voluntary hospitalist service.

Measurements: Length of stay, costs, 10-day readmission rates, use of consultative services, in-hospital mortality rate, and mortality rate at 30 and 60 days.

Results: Patients of hospitalists were younger than those of community physicians (65 years vs. 74 years; P < 0.001) and were more likely to be of black than of white ethnicity (33.3% vs. 17.9%; P < 0.001), have Medicaid insurance (25.1% vs. 10.2%; P < 0.001), and receive intensive care (19.9% vs. 15.8%; P < 0.001). After adjustment in multivariable models, length of stay and costs were not different in the first year of the study. In year 2, patients of hospitalists had shorter stays (0.61 day shorter; P = 0.002) and lower costs ($822 lower; P = 0.002). Over the 2 years of this study, patients of hospitalists had lower risk for death in the hospital (adjusted relative hazard, 0.71 [95% CI, 0.54 to 0.93]) and at 30 and 60 days of follow-up.

Conclusions: A voluntary hospitalist service at a community-based teaching hospital produced reductions in length of stay and costs that became statistically significant in the second year of use. A mortality benefit extending beyond hospitalization was noted in both years. Future investigations are needed to understand the ways in which hospitalists increase clinical efficiency and appear to improve the quality of care.

Editors' Notes Context Many studies suggest that hospitalists reduce average length of stay and costs but have little or no effect on patient survival. Contribution This 2-year cohort study from a community-based urban teaching hospital found that patients cared for by faculty hospitalists rather than community physicians had shorter lengths of stay, lower costs, and better in-hospital and 1- and 2-month survival rates. Implications Length of stay and cost benefits were apparent only in year 2 of the study, which suggests that experience is an important aspect of successful care by hospitalists. Cautions The study was retrospective, was done in a single site, and involved only five hospitalists. –The Editors

 

Author and Article Information

From University of California, San Francisco, and Institute for Health Policy Studies, San Francisco, California.

Acknowledgments: The authors thank Kenneth Woeber, MD, for assistance with planning this project; Linda Ono, BA, for work in assembling the database used in this study; Amy Markowitz, JD, for editorial assistance; and Kathleen Kerr, BA, for her efforts throughout the course of the study.

Potential Financial Conflicts of Interest:Grants received: L. Goldman.

Requests for Single Reprints: Andrew D. Auerbach, MD, MPH, Department of Medicine, Box 0120, 505 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143; e-mail, ada{at}medicine.ucsf.edu.

Current Author Addresses: Drs. Auerbach, Wachter, Baron, and Goldman: Department of Medicine, Box 0120, 505 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143.

Drs. Katz and Showstack: University of California, San Francisco, Institute for Health Policy Studies, Box 0936, LHts 265, San Francisco, CA 94143-0936.

Author Contributions: Conception and design: A.D. Auerbach, R.M. Wachter, J. Showstack, R.B. Baron, L. Goldman.

Analysis and interpretation of the data: A.D. Auerbach, P. Katz, J. Show-stack, R.B. Baron, L. Goldman.

Drafting of the article: A.D. Auerbach, J. Showstack, L. Goldman.

Critical revision of the article for important intellectual content: A.D. Auerbach, R.M. Wachter, P. Katz, J. Showstack, R.B. Baron, L. Goldman.

Final approval of the article: A.D. Auerbach, R.M. Wachter, P. Katz, J. Showstack, R.B. Baron, L. Goldman.

Provision of study materials or patients: A.D. Auerbach, R.B. Baron.

Statistical expertise: A.D. Auerbach, P. Katz, J. Showstack.

Administrative, technical, or logistic support: A.D. Auerbach, R.M. Wachter, R.B. Baron.

Collection and assembly of data: A.D. Auerbach, R.B. Baron.

Related articles in Annals:

Articles
Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists
David Meltzer, Willard G. Manning, Jeanette Morrison, Manish N. Shah, Lei Jin, Todd Guth, AND Wendy Levinson

Annals 2002 137: 866-874. [ABSTRACT][SUMMARY][Full Text]  

Editorials
The Who, What, When, Where, Whom, and How of Hospitalist Care
The Editors

Annals 2002 137: 930-931. [Full Text]  

Summaries for Patients
Hospitalists and the Costs and Outcomes of Hospital Care

Annals 2002 137: I-16. [Full Text]  

Letters
Improved Outcomes in a Voluntary Hospitalist Model
David Neely

Annals 2003 139: 76. [Full Text]  

Letters
Improved Outcomes in a Voluntary Hospitalist Model
Andrew D. Auerbach, Robert M. Wachter, AND Lee Goldman

Annals 2003 139: 76. [Full Text]  

Letters
Improved Outcomes in a Voluntary Hospitalist Model
James P. Nolan

Annals 2003 139: W-69. [Full Text]  

Letters
Hospitalist Care
William Rifkin, Brad Flansbaum, AND Steven Walerstein

Annals 2003 139: 702. [Full Text]  

Letters
Hospitalist Care
Jonathan P. Whitney

Annals 2003 139: 702-703. [Full Text]  

Letters
Hospitalist Care
Tariq Shafi

Annals 2003 139: 703. [Full Text]  

Letters
Hospitalist Care
Jerome S. Tannenbaum

Annals 2003 139: 703-704. [Full Text]  

Letters
Fumbled Handoffs
Tejal K. Gandhi

Annals 2005 143: 542-543. [Full Text]  

This article has been cited by other articles:

				D. Samoil Are inpatients' needs better served by hospitalists than by their family doctors: YES Can Fam Physician, August 1, 2008; 54(8): 1100 - 1101. [Full Text] [PDF]

				D. Samoil Les hospitaliers repondent-ils mieux aux besoins des patients hospitalises que leurs medecins de famille?: OUI Can Fam Physician, August 1, 2008; 54(8): 1104 - 1106. [Full Text] [PDF]

				M. V. Williams Hospitalists and the Hospital Medicine System of Care Are Good for Patient Care Arch Intern Med, June 23, 2008; 168(12): 1254 - 1256. [Full Text] [PDF]

				M. H. Al-Shaer, E. S. Suleiman, W. P. Jerome, E. S. Chu, R. K. Albert, M. Wei, D. van Amerongen, P. K. Lindenauer, M. B. Rothberg, and A. D. Auerbach Outcomes of Care by Hospitalists N. Engl. J. Med., April 17, 2008; 358(16): 1755 - 1758. [Full Text] [PDF]

				W. D. Freeman, G. Gronseth, and B. H. Eidelman Invited Article: Is it time for neurohospitalists? Neurology, April 8, 2008; 70(15): 1282 - 1288. [Abstract] [Full Text] [PDF]

				J. S. Tieder, D. S. Migita, C. A. Cowan, and S. M. Melzer Newborn Care by Pediatric Hospitalists in a Community Hospital: Effect on Physician Productivity and Financial Performance Arch Pediatr Adolesc Med, January 1, 2008; 162(1): 74 - 78. [Abstract] [Full Text] [PDF]

				P. K. Lindenauer, M. B. Rothberg, P. S. Pekow, C. Kenwood, E. M. Benjamin, and A. D. Auerbach Outcomes of Care by Hospitalists, General Internists, and Family Physicians N. Engl. J. Med., December 20, 2007; 357(25): 2589 - 2600. [Abstract] [Full Text] [PDF]

				L. F. McMahon Jr. The Hospitalist Movement -- Time to Move On N. Engl. J. Med., December 20, 2007; 357(25): 2627 - 2629. [Full Text] [PDF]

				F. Lehmann, Y. Brunelle, M. Dawes, R. Boule, and R. Bergeron Les implications du phenomene des medecins hospitaliers Can Fam Physician, December 1, 2007; 53(12): 2131 - 2131. [Abstract] [Full Text] [PDF]

				W. N. Southern, M. A. Berger, E. Y. Bellin, S. M. Hailpern, and J. H. Arnsten Hospitalist Care and Length of Stay in Patients Requiring Complex Discharge Planning and Close Clinical Monitoring Arch Intern Med, September 24, 2007; 167(17): 1869 - 1874. [Abstract] [Full Text] [PDF]

				L. Goldman and N. H. Fiebach Hippocrates Affirmed? Limiting Residents' Work Hours Does No Harm to Patients Ann Intern Med, July 17, 2007; 147(2): 143 - 144. [Full Text] [PDF]

				G. L. Freed, K. Brzoznowski, K. Neighbors, I. Lakhani, and American Board of Pediatrics, Research Advisory Co Characteristics of the Pediatric Hospitalist Workforce: Its Roles and Work Environment Pediatrics, July 1, 2007; 120(1): 33 - 39. [Abstract] [Full Text] [PDF]

				J. J. Glasheen, K. R. Epstein, E. Siegal, J. S. Kutner, and A. V. Prochazka The Spectrum of Community-Based Hospitalist Practice: A Call to Tailor Internal Medicine Residency Training Arch Intern Med, April 9, 2007; 167(7): 727 - 728. [Full Text] [PDF]

				B. D. Winters, P. J. Pronovost, and J. Pham Rapid Response Team Responses--Reply JAMA, January 10, 2007; 297(2): 155 - 155. [Full Text] [PDF]

				M. Ong, A. Bostrom, A. Vidyarthi, C. McCulloch, and A. Auerbach House Staff Team Workload and Organization Effects on Patient Outcomes in an Academic General Internal Medicine Inpatient Service Arch Intern Med, January 8, 2007; 167(1): 47 - 52. [Abstract] [Full Text] [PDF]

				B. D. Winters, J. Pham, and P. J. Pronovost Rapid Response Teams--Walk, Don't Run JAMA, October 4, 2006; 296(13): 1645 - 1647. [Full Text] [PDF]

				P. H. Conway, S. Edwards, E. R. Stucky, V. W. Chiang, M. C. Ottolini, and C. P. Landrigan Variations in Management of Common Inpatient Pediatric Illnesses: Hospitalists and Community Pediatricians Pediatrics, August 1, 2006; 118(2): 441 - 447. [Abstract] [Full Text] [PDF]

				C. P. Landrigan, P. H. Conway, S. Edwards, and R. Srivastava Pediatric Hospitalists: A Systematic Review of the Literature Pediatrics, May 1, 2006; 117(5): 1736 - 1744. [Abstract] [Full Text] [PDF]

				P. S. Lye, D. A. Rauch, M. C. Ottolini, C. P. Landrigan, V. W. Chiang, R. Srivastava, S. Muret-Wagstaff, and S. Ludwig Pediatric Hospitalists: Report of a Leadership Conference Pediatrics, April 1, 2006; 117(4): 1122 - 1130. [Abstract] [Full Text] [PDF]

				P. K. Lindenauer, R. Behal, C. K. Murray, W. Nsa, P. M. Houck, and D. W. Bratzler Volume, quality of care, and outcome in pneumonia. Ann Intern Med, February 21, 2006; 144(4): 262 - 269. [Abstract] [Full Text] [PDF]

				S. L. Ettner, J. Kotlerman, A. Afifi, S. Vazirani, R. D. Hays, M. Shapiro, and M. Cowan An Alternative Approach to Reducing the Costs of Patient Care? A Controlled Trial of the Multi-Disciplinary Doctor-Nurse Practitioner (MDNP) Model. Med Decis Making, January 1, 2006; 26(1): 9 - 17. [Abstract] [PDF]

				T. K. Gandhi Fumbled Handoffs Ann Intern Med, October 4, 2005; 143(7): 542 - 543. [Full Text] [PDF]

				J. Coffman and T. G. Rundall The Impact of Hospitalists on the Cost and Quality of Inpatient Care in the United States: A Research Synthesis Med Care Res Rev, August 1, 2005; 62(4): 379 - 406. [Abstract] [PDF]

				C. L. Roy, E. G. Poon, A. S. Karson, Z. Ladak-Merchant, R. E. Johnson, S. M. Maviglia, and T. K. Gandhi Patient Safety Concerns Arising from Test Results That Return after Hospital Discharge Ann Intern Med, July 19, 2005; 143(2): 121 - 128. [Abstract] [Full Text] [PDF]

				M. P. Phy, D. J. Vanness, L. J. Melton III, K. H. Long, C. D. Schleck, D. R. Larson, P. M. Huddleston, and J. M. Huddleston Effects of a Hospitalist Model on Elderly Patients With Hip Fracture Arch Intern Med, April 11, 2005; 165(7): 796 - 801. [Abstract] [Full Text] [PDF]

				R. Srivastava, C. Norlin, B. C. James, S. Muret-Wagstaff, P. C. Young, and A. Auerbach Community and Hospital-Based Physicians' Attitudes Regarding Pediatric Hospitalist Systems Pediatrics, January 1, 2005; 115(1): 34 - 38. [Abstract] [Full Text] [PDF]

				K. E. Hauer, R. M. Wachter, C. E. McCulloch, G. A. Woo, and A. D. Auerbach Effects of Hospitalist Attending Physicians on Trainee Satisfaction With Teaching and With Internal Medicine Rotations Arch Intern Med, September 27, 2004; 164(17): 1866 - 1871. [Abstract] [Full Text] [PDF]

				E. G. Neilson, K. B. Johnson, S. T. Rosenbloom, W. D. Dupont, D. Talbert, D. A. Giuse, A. Kaiser, R. A. Miller, and the Resource Utilization Committee* The Impact of Peer Management on Test-Ordering Behavior Ann Intern Med, August 3, 2004; 141(3): 196 - 204. [Abstract] [Full Text] [PDF]

				J. M. Huddleston, K. H. Long, J. M. Naessens, D. Vanness, D. Larson, R. Trousdale, M. Plevak, M. Cabanela, D. Ilstrup, R. M. Wachter, et al. Medical and Surgical Comanagement after Elective Hip and Knee Arthroplasty: A Randomized, Controlled Trial Ann Intern Med, July 6, 2004; 141(1): 28 - 38. [Abstract] [Full Text] [PDF]

				G. J. Merli The Hospitalist Joins the Surgical Team Ann Intern Med, July 6, 2004; 141(1): 67 - 69. [Full Text] [PDF]

				B. A. Sharpe Perceptions of Physician Shortages JAMA, April 14, 2004; 291(14): 1695 - 1696. [Full Text] [PDF]

				A. D. Auerbach and J. Kleinbart Update in Hospital Medicine Ann Intern Med, March 2, 2004; 140(5): 363 - 369. [Full Text] [PDF]

				T. Shafi Hospitalist Care Ann Intern Med, October 21, 2003; 139(8): 703 - 703. [Full Text] [PDF]

				W. Rifkin, B. Flansbaum, and S. Walerstein Hospitalist Care Ann Intern Med, October 21, 2003; 139(8): 702 - 702. [Full Text] [PDF]

				J. P. Whitney Hospitalist Care Ann Intern Med, October 21, 2003; 139(8): 702 - 703. [Full Text] [PDF]

				J. S. Tannenbaum Hospitalist Care Ann Intern Med, October 21, 2003; 139(8): 703 - 704. [Full Text] [PDF]

				J. P. Nolan Improved Outcomes in a Voluntary Hospitalist Model Ann Intern Med, September 2, 2003; 139(5_Part_1): W-69 - W-69. [Full Text] [PDF]

				D. Neely Improved Outcomes in a Voluntary Hospitalist Model Ann Intern Med, July 1, 2003; 139(1): 76 - 76. [Full Text] [PDF]

				J. R. Dichter Teamwork and Hospital Medicine: A Vision for the Future Crit. Care Nurse, June 1, 2003; 23(3): 8 - 11. [Full Text] [PDF]

				Do Hospitalists Improve Patient Outcomes? Journal Watch Gastroenterology, February 25, 2003; 2003(225): 7 - 7. [Full Text]

				Do Hospitalists Improve Patient Outcomes? Journal Watch (General), January 14, 2003; 2003(114): 4 - 4. [Full Text]

				D. Meltzer, W. G. Manning, J. Morrison, M. N. Shah, L. Jin, T. Guth, and W. Levinson Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists Ann Intern Med, December 3, 2002; 137(11): 866 - 874. [Abstract] [Full Text] [PDF]

				The Editors The Who, What, When, Where, Whom, and How of Hospitalist Care Ann Intern Med, December 3, 2002; 137(11): 930 - 931. [Full Text] [PDF]