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REPLY
Improved Outcomes in a Voluntary Hospitalist Model
Andrew D. Auerbach, MD, MPH;
Robert M. Wachter, MD; and
Lee Goldman, MD
1 July 2003 | Volume 139 Issue 1 | Page 76
IN RESPONSE:
We disagree with the statement that "if doctors know that one of their explicit goals is to expedite patient discharge, it will happen." The site of our study was indeed experiencing financial difficulties, but these difficulties were visible to all physicians and expedited discharges were a priority for everyone. However, only hospitalists were able to improve clinical efficiency while simultaneously improving patient outcomes.
The traditional model may preserve continuity, but at the price of inefficient care and, perhaps, poorer outcomes (1). Notwithstanding the shortcomings of our study or others, many outpatient-based generalists now routinely refer their inpatients to hospitalists, a pattern cemented by their satisfaction with the model's positive effects on their patients and practice (2). As a result, hospital care from a hospitalist is routine—a hospitalist is yet another "specialist" to whom patients are referred. Thus, the more relevant challenge to our specialty is how we can retain closeness and continuity in all generalist–specialty interactions, not only those in which hospitalists are involved.
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Author and Article Information
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University of California, San Francisco; San Francisco, CA 94143 (Auerbach, Wachter, Goldman)
1. Meltzer D, Manning WG, Morrison J, Shah MN, Jin L, Guth T, et al. Effects of physician experience on costs and outcomes on an academic general medicine service: results of a trial of hospitalists Ann Intern Med. 2002;137:866-74. [PMID: 12458986].[Abstract/Free Full Text]
2. Auerbach AD, Aronson M, Davis RB, Phillips RS. Anticipation vs. reality: how physicians view hospitalist services after implementation. Arch Intern Med. 2003; [In press].
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Implementation of a Voluntary Hospitalist Service at a Community Teaching Hospital: Improved Clinical Efficiency and Patient Outcomes
Andrew D. Auerbach, Robert M. Wachter, Patricia Katz, Jonathan Showstack, Robert B. Baron, AND Lee Goldman
- Annals 2002 137: 859-865.
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