Dataset Information

Improved Inpatient Care through Greater Patient-Doctor Contact under the Hospitalist Management Approach: A Real-Time Assessment.

ABSTRACT:

Objective

To examine the difference between hospitalist and non-hospitalist frequency of patient-doctor contact, duration of contact, cumulative contact time, and the amount of time taken by the doctor to resolve an issue in response to a medical call. Research Design and Measures: Data from 18 facilities and 36 wards (18 hospitalist wards and 18 non-hospitalist wards) were collected. The patient-doctor contact slip and medical call response slips were given to each inpatient ward to record. A total of 28,926 contacts occurred with 2990 patients, and a total of 8435 medical call responses occurred with 3329 patients. Multivariate logistic regression analyses and regression analyses were used for statistical analyses.

Results

The average frequency of patient-doctor contact during a hospital stay was 10.0 times per patient for hospitalist patients. Using regression analyses, hospitalist patients had more contact with the attending physician (β = 5.6, standard error (SE) = 0.28, p < 0.0001). Based on cumulative contact time, hospitalists spent significantly more time with the patient (β = 32.29, SE = 1.54, p < 0.0001). After a medical call to resolve the issue, doctors who took longer than 10 min were 4.14 times (95% CI 3.15-5.44) and those who took longer than 30 min were 4.96 times (95% CI 2.75-8.95) more likely to be non-hospitalists than hospitalists.

Conclusion

This study found that hospitalists devoted more time to having frequent encounters with patients. Therefore, inpatient care by a hospitalist who manages inpatient care from admission to discharge could improve the care quality.

SUBMITTER: Chae W

PROVIDER: S-EPMC8198090 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundDespite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient 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 who maintain hospital privileges with concurrent outpatient practices.MethodsArticles 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 attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance.ResultsThe majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); 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 has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37).ConclusionsFuture research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality.