The Fight to Prove the Value of Hospitalists

Karen M. Cheung , August 31, 2009

A new study is generating talk about the value of hospitalists and what they actually do for quality. Hospitalists, or hospital physicians dedicated to inpatient care, serve clinical positions, and oftentimes administrative, teaching, and leadership roles. Researchers at Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard University in Boston found that hospitals with hospitalists performed better than hospitals without.

"We now know for sure that, nationally, hospitals with hospitalists show better quality scores," said lead author Lenny Lopez, MD, MPH, hospitalist at Brigham and Women's Hospital, instructor at Harvard Medical School, and assistant in health policy at the Massachusetts General Hospital Institute for Health Policy.

Study details
The study, "Hospitalists and the Quality of Care in Hospitals," published in the August issue of Archives of Internal Medicine, looked at more than 3,600 hospitals in the country. It linked national measures from the Hospital Quality Alliance, under the Centers for Medicaid and Medicare Services, with data from the American Hospital Association, regarding three quality indicators: acute myocardial infarction, congestive heart failure, and pneumonia.

What researchers found was promising. Institutions that utilized hospitalists scored higher in two of the three quality markers: acute myocardial infarction and pneumonia, although there was no difference in congestive heart failure cases. Why?

Study authors believe that hospitalists link to quality but admit there may be other things inside the hospital at play.

"There are other things that contribute to high hospital scores," said Lopez about nurse staff ratios and health information technology. "Hospitalists are one of a series of things that improve overall quality; they are definitely a contributing factor," he said.

The legacy of hospital medicine
Proving the value of hospitalists has been a question since the inception of hospital medicine in 1996 when the word "hospitalist" was first coined: Do hospitalists improve care? Do they help the bottom line?

With more than 20,000 hospitalists in the U.S., according to the Society of Hospital Medicine, this practice is the fastest growing specialty in the nation. But it isn't always the most lucrative. These types of hospitals with hospitalists tend to be nonprofit, large, teaching facilities in southern states, according to the study, and often cater to non-procedure-based practice that includes the uninsured and underinsured population.

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