Key result
Every 10% increase in patients admitted by hospitalists was associated with 0.5% to 1.5% fewer missed quality opportunities for AMI, CHF, and pneumonia (P<0.001 to P=0.006).
Why the study?
Does the presence of hospitalists improve performance on publicly reported quality process measures for AMI, CHF, and pneumonia in California hospitals?
Cross-Sectional (n=208)
Yes
Does the presence of hospitalists improve performance on publicly reported quality process measures for AMI, CHF, and pneumonia in California hospitals?
p-value: p=<0.001
The presence and higher utilization of hospitalists are associated with modest improvements in adherence to publicly reported quality process measures for AMI, CHF, and pneumonia.
May support hospitalist models to improve adherence; leaves open causality and generalizability beyond California.
BACKGROUND: Hospital leaders usually provide financial support to hospitalists groups, often with an expectation of improved performance on publicly reported quality metrics. Whether the presence of hospitalists is associated with differences in hospital-level performance is unknown. OBJECTIVE: Assess the relationship between hospitalist prevalence and quality performance. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 208 California hospitals participating in a voluntary reporting initiative. INTERVENTION: Survey of hospital personnel with knowledge of the utilization of hospitalists for patient care. MEASUREMENTS: Sixteen publicly reported quality process measures across 3 medical conditions: acute myocardial infarction (AMI); congestive heart failure (CHF); and pneumonia. Using multivariable models, we assessed the relationship between the presence of hospitalists and the percentage of missed quality opportunities for each process measure. RESULTS: Of 208 eligible hospitals, 170 (82%) had hospitalist services. After adjustment, hospitals with hospitalists had similar performance for cardiac and pneumonia measures assessed at admission and fewer missed processes for CHF measures assessed at discharge. Among sites with hospitalists, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P < 0.001) missed quality opportunities for AMI at admission, and 0.6% (P < 0.001), 0.5% (P = 0.004), and 1.5% (P = 0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively. CONCLUSIONS: The presence of hospitalists in California was associated with modest improvements in performance on publicly reported process measures. Whether hospitalists directly improve quality or simply reflect a hospital's level of investment in quality remains a subject for future study.
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Vasilevskis et al. (2010) conducted a cross-sectional in Acute myocardial infarction, congestive heart failure, and pneumonia (n=208). Hospitalist prevalence vs. Hospitals without hospitalists or lower hospitalist prevalence was evaluated on Percentage of missed quality opportunities for 16 publicly reported quality process measures (p=<0.001). Every 10% increase in patients admitted by hospitalists was associated with 0.5% to 1.5% fewer missed quality opportunities for AMI, CHF, and pneumonia (P<0.001 to P=0.006).
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