Key result
While there is significant variation among hospitalists in patient length of stay and discharge destination, hospitalists contributed only 0.18% to the total variance in 30-day readmission rates and 0.75% to 30-day mortality.
Why the study?
Does the individual hospitalist significantly contribute to variation in length of stay, discharge destination, and 30-day outcomes among hospitalized Medicare patients?
Observational (n=131,710)
Yes
Does the individual hospitalist significantly contribute to variation in length of stay, discharge destination, and 30-day outcomes among hospitalized Medicare patients?
Hospitalists contribute to variation in length of stay and discharge destination, but have minimal impact on 30-day readmission and mortality rates, which are primarily driven by patient case mix and hospital factors.
Minimal hospitalist contribution to 30-day outcome variance suggests limited benefit from targeting individual providers; leaves open the dominant role of case mix and hospital factors.
BACKGROUND: There have been no prior population-based studies of variation in performance of hospitalists. OBJECTIVE: To measure the variation in performance of hospitalists. DESIGN: Retrospective research design of 100 % Texas Medicare data using multilevel, multivariable models. SUBJECTS: 131,710 hospitalized patients cared for by 1,099 hospitalists in 268 hospitals from 2006-2009. MAIN MEASURES: We calculated, for each hospitalist, adjusted for patient and disease factors (case mix), their patients' average length of stay, rate of discharge home or to skilled nursing facility (SNF) and rate of 30-day mortality, readmissions and emergency room (ER) visits. KEY RESULTS: In two-level models (admission and hospitalist), there was significant variation in average length of stay and discharge location among hospitalists, but very little variation in 30-day mortality, readmission or emergency room visit rates. There was stability over time (2008-2009 vs. 2006-2007) in hospitalist performance. In three-level models including admissions, hospitalists and hospitals, the variation among hospitalists was substantially reduced. For example, hospitals, hospitalists and case mix contributed 1.02 %, 0.75 % and 42.15 % of the total variance in 30-day mortality rates, respectively. CONCLUSIONS: There is significant variation among hospitalists in length of stay and discharge destination of their patients, but much of the variation is attributable to the hospitals where they practice. The very low variation among hospitalists in 30-day readmission rates suggests that hospitalists are not important contributors to variations in those rates among hospitals.
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Goodwin et al. (2012) conducted an observational in Hospitalized Medicare patients (n=131,710). Hospitalist care was evaluated on Variation in length of stay, discharge destination, and 30-day outcomes. While there is significant variation among hospitalists in patient length of stay and discharge destination, hospitalists contributed only 0.18% to the total variance in 30-day readmission rates and 0.75% to 30-day mortality.
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