Key result
Pediatric hospitalist systems were associated with 6% to 14% shorter lengths of stay in some studies compared to traditional models, though effects on readmissions and costs were mixed.
Why the study?
Do pediatric hospitalist systems improve quality and cost outcomes compared to traditional models of care in pediatric inpatients?
Systematic Review (n=11)
Do pediatric hospitalist systems improve quality and cost outcomes compared to traditional models of care in pediatric inpatients?
Pediatric hospitalist systems can improve the quality and efficiency of inpatient care, but the benefits are not universal and require further comparative effectiveness research.
May support selective pediatric hospitalist adoption for efficiency; leaves open readmission and cost effects, needing further comparative trials.
BACKGROUND: Pediatric hospitalist systems are increasing in popularity, but data regarding the effects of hospitalist systems on the quality of care has been sparse, in part because rigorous metrics for analysis have not yet been established. We conducted a literature review of studies comparing the performance of pediatric hospitalists and traditional attendings. OBJECTIVE: To determine the effect of pediatric hospitalists on quality and outcome metrics such as length of stay, cost, patient satisfaction, mortality, readmission rates, and use of evidence-based medicine during care. RESULTS: A Medline literature search identified 11 studies that met criteria for inclusion. Five previously reviewed studies reported lengths of stay between 6% and 14% shorter for hospitalists. Five of the new studies evaluated lengths of stay, with 1 showing significantly lower length of stay and cost for a faculty model, 1 showing lower length of stay for hospitalists for all conditions, 1 for certain conditions only, and 2 showing no statistical difference. Six studies reported on readmission rate, with 4 showing no difference, 1 showing decreased readmissions for hospitalists, and 1 showing decreased readmissions for a traditional faculty service. Hospitalists self-report higher use of evidence-based guidelines. Few differences in patient satisfaction were reported. Mortality on the pediatrics wards is rare, and no studies were adequately powered to evaluate mortality rate. CONCLUSION: Hospitalists can improve the quality and efficiency of inpatient care in the pediatric population, but the effect is not universal, and mechanisms underlying demonstrated improvements are poorly understood. We propose 4 components to improve quality and value in hospital medicine systems: investment in comparative effectiveness research involving delivery system interventions, development and implementation of pediatric quality measures, better understanding of improvement mechanisms for hospital medicine systems, and increased focus on quality and value delivered by hospital medicine groups and individuals.
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Mussman et al. (2011) conducted a systematic review in Pediatric inpatient care (n=11). Pediatric hospitalist systems vs. Traditional attendings / traditional models of care was evaluated on Quality and outcome metrics including length of stay, cost, patient satisfaction, mortality, readmission rates, and use of evidence-based medicine. Pediatric hospitalist systems were associated with 6% to 14% shorter lengths of stay in some studies compared to traditional models, though effects on readmissions and costs were mixed.
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