Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Hospitalists”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMed2007

Redefining the community pediatric hospitalist: the combined pediatric ED/inpatient unit.

BACKGROUND: The use of pediatric hospitalists in community hospitals has increased over the past decade in response to the desire to provide high-quality pediatric care. Many hospitals are challenged to create financially independent and productive programs. OBJECTIVE: To evaluate an alternative approach to traditional community hospital pediatric care of having pediatricians work in a combined pediatric Emergency Department (PED)/inpatient unit. DESIGN/METHODS: Franklin Square Hospital Center converted its pediatric hospitalist program from a traditional inpatient with partial Emergency Department (ED) coverage program to one that covers a combined PED/inpatient unit. Outcome categories were compared between the year before opening, 2003, to the year after, 2004. Measures included total part B billing, overall patient satisfaction scores for the PED and inpatient unit from the Press Ganey patient satisfaction survey, perception of wait times and time to admission, and risk-adjusted inpatient length of stay (ALOS). RESULTS: Part B billings from the 5.5 Full Time Equivalent (FTE) pediatric hospitalists increased 82% from increased 61% from 2003 to 2004, from 1,631,583 dollars in 2003 to 2,967,715 dollars in 2004 as a result of increased volume of ED patients seen by pediatricians. The mean inpatient satisfaction score did not significantly change, 75.7 in 2003 and 79.0 in 2004 (P = 0.432), but the mean PED score significantly increased from 75.8 to 83.4 (P = 0.0001). Mean scores of the efficiency measures on the survey increased for PED patients, with the mean score for wait time to treatment increasing from 62.0 to 75.3 (P < 0.0001). Total throughput time through the ED improved significantly as well from 143 minutes to 122 minutes (P = 0.0003). Risk-adjusted length of stay performance did not change; for calendar year 2003, the mean monthly ALOS was 1.883 (95% range 1.503, 2.263), compared with a 2004 mean monthly ALOS of 1.869 (95% range 1.523, 2.216). CONCLUSIONS: Implementation of a combined PED/inpatient unit was associated with increased billing by hospitalists, increased satisfaction scores of ED patients, and decreased ED throughput times. Pediatric hospitalist programs that want to improve financial and patient outcomes in a community setting could consider adopting the combined unit approach.

Emergency Service, Hospital↗
PubMed2001

Physician views on caring for hospitalized patients and the hospitalist model of inpatient care.

We surveyed 241 board-certified internists affiliated with a large teaching hospital (Boston, Mass) before implementing a hospitalist service to determine attitudes towards providing inpatient care and the hospitalist model. Of physicians surveyed, 66% responded. Most disagreed that inpatient care is "an inefficient use of my time," only 10% felt a hospitalist service would improve patient satisfaction, and 54% felt it would hurt patient-doctor relationships. Multivariable analyses suggest that physicians physically furthest from their inpatient site were had more favorable attitudes toward the hospitalist model; more experienced and busier physicians were more negative. Future investigations should determine strategies for implementing the hospitalist model which address physicians' concerns.

Academic Medical Centers↗
PubMed2005

The impact of hospitalists on the cost and quality of inpatient care in the United States: a research synthesis.

There is substantial disagreement regarding the impact of hospitalists on costs, quality, and satisfaction with inpatient care. The authors reviewed 21 evaluations of the use of hospitalists in U.S. hospitals. Most evaluations found that patients managed by hospitalists had lower total costs or charges than patients in comparison groups and that these savings were achieved primarily by reducing length of stay. Most evaluations found no statistically significant differences in quality of care or satisfaction. However, lack of random assignment limits the ability to draw causal inferences from many of the evaluations. All randomized studies were conducted in teaching hospitals, raising questions as to the generalizability of findings to nonteaching hospitals. Further research is needed to better identify the mechanisms by which hospitalists reduce length of stay and to ascertain which types of hospitalist programs are most effective and which patients are most likely to benefit.

Health Services Research↗
PubMed2005

Guiding principles for pediatric hospitalist programs.

Pediatric hospitalist programs have become increasingly popular recently, emulating the growth and success of adult hospitalist programs. This statement provides an overview of hospitalist programs, factors influencing their growth, and their expected benefits. Six guiding principles for the establishment of pediatric hospitalist programs are identified in this statement concerning voluntary referrals; local design; minimum physician-training requirements; arrangement for appropriate follow-up; communication among primary care physicians, subspecialists, and hospitalists; and data collection and outcome measurements.

Hospitalists↗
PubMed2004

CEO's perceptions of hospitalists: diffusion of the strategy.

Many hospitals have initiated a strategy to reduce costs and improve quality of care by using physicians as "hospitalists." A hospitalist specializes in inpatient care. This article reports the findings of survey research examining CEO perceptions of the hospitalist model, with particular interest in diffusion of the strategy in rural and low managed care hospital markets. Findings indicate there is less diffusion of the hospitalist model to rural areas because of lack of information about the cost effectiveness of the program and medical staff resistance. Recommendations to increase adoption of the hospitalist strategy include educating about the benefits of the strategy and paying attention to areas of concern by the medical staff.

Attitude of Health Personnel↗
PubMed2003

Community pediatricians collaborate with hospitalists to build a ward service.

Variations in hospitalist models carry advantages and disadvantages, many of which can be elucidated through the guidance of an experienced consultant or director. Implementation presents several challenges. Although there are common themes among various types of hospitalist programs, the specific activities of the team must be carefully tailored to the needs of the ward. The ideal would be to dovetail the hospitalist's activities with those of other services in the hospital, according to the preferences and expressed needs of the medical staff and hospital administration. This is an ambitious and elusive goal. One common thread is that the choice of hospitalist service requires considerable input from the community physicians in order to ensure success of the program. Program directors, hospital administrators, and medical staff organizations are strongly encouraged to seek the pediatricians' input early in the planning stages and throughout the course of design and implementation. In the end, a hospitalist program may serve to raise the level of care on the ward, support the needs of community pediatricians, and bring a new level of efficiency, consistency, and specialization to the care of the community's children.

Child↗
PubMed2003

Pediatric hospitalists fill varied roles in the care of newborns.

The use of hospitalists in the care of newborns appears to be increasing and may be advantageous for several reasons, including decreased cost, decreased length of stay, increased patient survival, increased availability, and greater experience among hospitalists. Research specific to the use of hospitalists in newborn medicine needs to be done to support this hypothesis. Non-clinical activities such as teaching, developing clinical guidelines, and taking an active role in hospital and academic leadership also may improve education and patient care. It is essential that hospitalists who provide care in nurseries work to smooth the transition to a PCP and not act as a barrier. Relatively speaking, the care provided by hospitalists is most often short-term, and the relationship between infants and their parents with the PCP should begin as soon as possible.

Hospitalists↗
PubMed1999

An introduction to the hospitalist model.

Motivated by a search for improved quality and efficiency, increasing numbers of hospitals and physicians are moving from systems in which all primary care providers manage their own hospitalized patients or rotate this responsibility among themselves at infrequent intervals to voluntary or mandatory systems in which patients are "handed off" to the care of an inpatient physician, the "hospitalist." All hospitalists manage medical patients in the hospital. Other potential roles for these physicians include triage in the emergency department, transfer of "out-of-network" patients, management of patients in the intensive care unit, preoperative and postoperative management of surgical patients, and leadership in hospital quality improvement and regulatory work. Hospitalists may add value by being more available to inpatients, having more hospital experience and expertise, and having an increased commitment to hospital quality improvement compared with primary care providers. Potential disadvantages of the hospitalist model include loss of information as a result of discontinuity of care, patient dissatisfaction, loss of acute care skills by primary care physicians, and burnout among hospitalists. A variety of models of care are needed to meet the clinical, organizational, financial, and political demands of diverse health care systems. The favored model should be that which produces the best clinical outcomes and the highest patient satisfaction at the lowest cost.

Hospitalists↗
PubMed1999

The hospitalist: new boon for internal medicine or retreat from primary care?

The growing reliance on hospitalists in the United States has implications for several areas of internal medicine, including patient care, administration, clinical practice, and medical education. This paper discusses some of the potential advantages and disadvantages of the use of hospitalists in each of these areas. The new hospitalist practice mode highlights long-standing tensions about the role and direction of internal medicine, tensions that affect generalist and specialty care in both outpatient and hospital settings. The career trajectory of hospitalists will depend on whether burnout is a problem and on whether hospitalists will be able to compete effectively with sub-specialists, such as cardiologists and physicians specializing in AIDS. Clearly, hospitalism meets a clinical need and expands opportunities for internists, but it is important that it not overreach, forfeiting primary care turf and distorting medical education. This new field warrants close monitoring because of its potential effects and because-unlike related fields, such as emergency medicine and intensive care--its birth was strongly influenced by system-wide financial considerations.

Adult↗
PubMedDate not supplied

How to design a hospitalist service. An academic health system case study.

Medical centers throughout the country are employing hospitalists--dedicated inpatient specialists--to care for patients during hospitalization in place of their primary care provider. There has been expansive growth of hospitalist programs as the number of practicing hospitalists has doubled in two years from approximately 1,500 to over 3,000. In July 1997, the department of medicine at University Hospitals of Cleveland, the primary teaching affiliate of Case Western Reserve University, created a hospitalist service. This paper will discuss the design of a hospitalist service at a major academic medical center, the factors that were considered during the design stage and financial feasibility.

Academic Medical Centers↗
PubMed1999

Very different hospitalist models deliver same outcomes' benefits.

Hospitalists: How do they fit in? The hospitalist model of care is expanding in the United States. The model gets "tweaked" to suit the needs of the systems in which it takes hold. Cost and efficiency data notwithstanding, some hospitals implementing a hospitalist model are motivated solely by patient care quality concerns. A hospitalist service can be an amenity for physicians offered by a hospital. Potential hospitalists need to be carefully screened for what is a very demanding job.

Hospitalists↗
PubMed2004

Comparison of hospital costs and length of stay associated with general internists and hospitalist physicians at a community hospital.

OBJECTIVE: To compare initial and long-term hospital resource utilization of hospitalists and general internists at an urban community hospital. STUDY DESIGN: A retrospective cohort analysis. METHODS: Data were collected from 11 750 admissions associated with 28 diagnosis-related groups for 6 years (October 1, 1994, to September 30, 2000). Hospital cost, length of stay, mortality, and 30-day readmission rates of general and hospitalist internists were analyzed for comparison. RESULTS: Hospitalists had generally lower utilization compared with general internists. Overall, length of stay and hospital cost were 16.1% and 8.3% lower, respectively, for hospitalists. Hospital mortality and 30-day readmissions were similar for both physician groups. CONCLUSIONS: Hospital resource utilization is moderately lower for hospitalists compared with private practicing general internists.

Cohort Studies↗
PubMed1998

Hospitalists: an efficient, new breed of inpatient caregivers.

Hospitalists are a relatively new segment of the physician population (primarily internists and critical care practitioners) specializing in managing the overall care of hospitalized patients, a responsibility traditionally assumed by primary care physicians. Managed care organizations, large medical groups, practice management companies, and hospitals that have adopted inpatient programs incorporating hospitalists report reductions in length of patient stays, decreased costs, and improved efficiency of delivery, with no adverse effect on patient satisfaction. Use of hospitalists is being encouraged by some managed care organizations, but local medical communities remain largely resistant to the introduction of hospitalist programs. Healthcare systems should proactively evaluate the benefits of instituting a hospitalist program.

Attitude of Health Personnel↗
PubMed2006

Reflections: the hospitalist movement a decade later.

August 2006 marks the 10th anniversary of the publication of an article in the New England Journal of Medicine in which Lee Goldman and I coined the term hospitalist-an event that many people characterize as the start of the hospitalist movement in the United States. The present article describes the history of those early days, highlighting some of the choices the field's initial leaders made to nurture the new specialty. In retrospect, although there were many examples of fortunate serendipity, there were also several key strategic choices, including the focus on gathering research data to demonstrate the value of the field to external stakeholders; the forceful rejection of mandatory hospitalist systems, particularly those promoted by managed care organizations; and the purposeful linking of our new field to the burgeoning movements to improve quality and patient safety in hospitals. Most of all, the field's spectacular growth and successes can be attributed to the daily work of thousands of hospitalists in clinical care, education, research, and systems improvement. These individuals have given life to our theoretical notion a decade ago that a new model for inpatient care would improve the American health care system and the care of inpatients.

Delivery of Health Care↗
PubMed2001

Key legal principles for hospitalists.

In a hospitalist system, when a patient leaves the hospital, he or she will return to a primary care provider (PCP) for follow-up and continuing care. The hand-off after discharge can compromise communication with the PCP. Physicians have a legal duty to provide follow-up care to patients with whom they have a relationship. The obligation to provide follow-up care endures even when the patient misses a scheduled appointment or does not adhere to the follow-up regimen. In general, the physician who began the care must fulfill that obligation. An essential component of follow-up care includes educating the patient about what symptoms require follow-up care and why it is important. The duty to provide adequate follow-up care is shared by the hospitalist and the PCP. Virtually no malpractice case law considers the obligations and practices of hospitalists. This article uses cases involving follow-up care for patients treated in an emergency department and general cases regarding liability for follow-up care to examine the potential legal obligations of both hospitalists and PCPs for follow-up care, including circumstances involving pending test results and incidental findings.

Abortion, Legal↗
PubMed2002

Key legal principles for hospitalists.

In a hospitalist system, when a patient leaves the hospital, he or she will return to a primary care provider (PCP) for follow-up and continuing care. The hand-off after discharge can compromise communication with the PCP. Physicians have a legal duty to provide follow-up care to patients with whom they have a relationship. The obligation to provide follow-up care endures even when the patient misses a scheduled appointment or does not adhere to the follow-up regimen. In general, the physician who began the care must fulfill that obligation. An essential component of follow-up care includes educating the patient about what symptoms require follow-up care and why it is important. The duty to provide adequate follow-up care is shared by the hospitalist and the PCP. Virtually no malpractice case law considers the obligations and practices of hospitalists. This article uses cases involving follow-up care for patients treated in an emergency department and general cases regarding liability for follow-up care to examine the potential legal obligations of both hospitalists and PCPs for follow-up care, including circumstances involving pending test results and incidental findings.

Abortion, Legal↗
PubMed2002

Organizing a hospitalist program: an overview of fundamental concepts.

This article has discussed several fundamental concepts in the development and implementation of a hospitalist program. Perhaps the two most important barriers to the success of hospitalist practices are lack of buy-in from PCPs and other physicians (which is becoming much less common) and the inability to gain durable financial support from the hospital or other sponsoring entity. These issues always should be addressed before starting a program. Systems for adequate communication between hospitalists and community physicians will ensure buy-in is maintained. Unique challenges for those administering a hospitalist group include physician scheduling that balances continuity with a sustainable career track. Finally, providing leadership with a medical director increases the likelihood that operational problems are quickly managed, and that strategic planning takes place to ensure the future success of the program.

Attitude of Health Personnel↗
PubMed2001

Hospitalists and the doctor-patient relationship.

Hospitalists--physicians whose practice focuses on the care of hospitalized general medicine patients--are increasingly common in the United States, often displacing primary care physicians from this role. While advocates of hospitalists point to evidence of cost reduction and perhaps improved short-run outcomes, critics question whether costs or long-run outcomes are improved and whether there may be insidious effects on the doctor-patient relationship. I define a framework for addressing these questions, assess the available evidence, and identify a research agenda to better understand the implications of the hospitalist movement for the doctor-patient relationship. Using a framework that emphasizes general and patient-specific knowledge as crucial to a successful doctor-patient relationship, I argue that the success of the hospitalist model will depend on its ability to continue to develop its areas of technical expertise while ensuring care that is both continuous and appropriate to the needs and values of individual patients.

Cost-Benefit Analysis↗