Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

White, Heather L; Glazier, Richard H

doi:10.1186/1741-7015-9-58

Table 1 Summary of articles evaluating hospitalist performance (n = 65)^a

From: Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

							Hospitalist performance
Source	Design	Hospital type	Study population	Sample	Comparison	Quality score	Processes of care	Operating efficiency	Patient outcomes
Abenhaim et al. [44]	RC	Teaching	Adults admitted to either GMS or medical short-stay unit	2,722	F vs. TWS	8	↑,*,ǂ	↑,*,ǂ	↑,*,ǂ
Auerbach et al. [85]	RC	Teaching	Adults admitted to GMS	5,308	A vs. C	24	-	↑	↑
Auerbach and Pantilat [76]	RC	Teaching	Adults admitted to GMS who died while in hospital	148	A vs. C	21	↑		↑
Batsis et al. [94]	B/A	Teaching	Seniors admitted for surgical repair of hip fracture	466	F^b vs. TWS	13			-,*
Bekmezian et al. [79]	RC	Paediatric teaching	Paediatric patients with oncologic, hematologic or gastroenterologic disease	925	F vs. TWS	17		↑	↓,*
Bell et al. [52]	QE	Teaching (six sites)	All patients admitted to GMS	1,078	Mixed practice types	6	-,*
Bellet and Whitaker [80]	B/A	Paediatric teaching	Paediatric patients admitted to GMS	1,440	A vs. TWS and C	24	-,*	↑	↓,*
Boyd et al. [95]	RC	Teaching	Paediatric patients admitted to GMS	1,009	P vs. TWS	16		↓
Carek et al. [96]	RC	Community	Adults admitted to GMS	5,453	P vs. C P vs. TWS	21		↓,* ↓	-,* -
Craig et al. [61]	RC	Community (16 sites)	Adults admitted from one HMO to GMS		P vs. C	8		↑,ǂ	-,ǂ
Davis et al. [65]	RC	Community	All patients admitted to GMS	2,124	P^c vs. C	13	↑,*	↑	-
Dhuper and Choksi [86]	B/A	Teaching	All patients admitted to GMS	10,966	A^c vs. TWS	14			↑,*
Diamond et al. [13]	B/A	Teaching	Adults admitted to GMS	3,299	A vs. C	16		↑,*	↑,*
Dwight et al. [45]	RC	Paediatric teaching	Paediatric patients admitted to GMS	3,807	F vs. TWS	22	-	↑	-
Dynan et al. [97]	RC	Teaching	All patients admitted to GMS	5,543	F^c vs. TWS	14		↑	-
Everett et al. [98]	RC	Community	All patients admitted to GMS	11,750	P vs. C	15		↑	-
Everett et al. [87]	RC	Teaching	All patients admitted to GMS	22,792	P vs. C P vs. TWS	14		↑ ↓	- ↑
Freese et al. [60]	B/A	Community	All patients admitted to GMS		P vs. C	6	↑,*,ǂ	↑,*,ǂ
Gittell et al. [63]	RC	Community	All patients admitted to GMS	6,686	P vs. C	7		↑	↑
Go et al. [51]	QE	Teaching (six sites)	Adults admitted to GMS with diagnosis of acute upper gastrointestinal haemorrhage	450	A vs. TWS	22	-,*	↓	-
Gregory et al. [99]	B/A	Teaching	All patients admitted to GMS	402	F vs. TWS	8		↑,*	-,*
Hackner et al. [68]	PC	Teaching	Adults on Medicaid admitted to GMS	1,637	A vs. C	19	↑,*	↑,*	-,*
Halasyamani et al. [100]	RC	Teaching	Adults admitted to GMS	10,595	P vs. C A vs. C	21		↑ ↑	- -
Huddleston et al. [48]	RCT	Teaching	Adults undergoing elective hip or knee arthroplasty	469	F^b vs. TWS	26		↑	↑
Kaboli et al. [50]	QE	Teaching	All patients admitted to GMS	1,706	A vs. TWS	23		↑	-
Kearns et al. [56]	QE	Teaching	All patients admitted to GMS	4,455	A vs. TWS	26	-,*	-	-
Khasgiwali et al. [101]	RC	Teaching	All patients admitted to GMS	1,916	P and A vs. TWS	14	-,*	-,*	-,*
Krantz et al. [58]	B/A	Teaching	All patients admitted to chest pain observational unit	493	P^b vs. TWS	19		↑,*	-,*
Kulaga et al. [78]	RC	Teaching	All patients admitted to GMS	2,707	A vs. C	8		↑,*,ǂ	↑,*
Kuo et al. [102]	RC	Mixed (4,359 sites)	5% national sample of admissions among Medicare beneficiaries	314,590	Mixed practice types	16		↑
Landrigan et al. [103]	TS	Paediatric teaching	Paediatric patients admitted to GMS from three HMOs	7,748	A^c vs. C	15		↑	-
Lindenauer et al. [74]	RC	Teaching	Adults admitted with heart failure	326	P and A vs. C	14	↑	↑	-,*
Lindenauer et al. [92]	RC	Mixed (45 sites)	Adults admitted with pneumonia, heart failure, chest pain, stroke, UTI, COPD or acute MI	76,926	Mixed practice types	20		↑	-
Maa et al. [62]	B/A	Teaching	Adults undergoing surgical appendectomy		A vs. TWS	7		↑,*
Meltzer et al. [54]	QE	Teaching	All patients admitted to GMS	6,511	A vs. TWS	20		↑	↑
Molinari and Short [104]	B/A	Community	Adults admitted from one HMO	1,319	P^c vs. C	8		↑
Ogershok et al. [66]	B/A	Paediatric teaching	Paediatric patients admitted to GMS	2,177	A vs. TWS	14	↑,*	↑,*	-,*
Palacio et al. [88]	RC	Teaching	All patients admitted to GMS	5,943	F vs. TWS	11		↑,*	↑
Palmer et al. [49]	QE	Teaching	All patients admitted to GMS	2,464	A^c vs. TWS	25	↑,*	↑	↑
Parekh et al. [105]	RC	Teaching	All patients admitted to GMS	2,552	A vs. TWS	19		-	-
Phy et al. [82]	B/A	Teaching	Older adults admitted for surgical repair of hip fracture	466	F^b,c vs. TWS	15		↑	-,*
Pinzuer et al. [77]	B/A	Teaching	Adults admitted for lower-extremity salvage or reconstructive surgery	140	F^b vs. TWS	9		↑	↓,ǂ,*
Ravikumar et al. [83]	B/A	Teaching (four sites)	Adult surgical patients	39,769	F^b,c vs. TWS	8		↓,ǂ,*	↓,*
Reddy et al. [72]	RC	Teaching	All patients admitted with community-acquired pneumonia	151	A vs. C and TWS	9	-	-
Rifkin et al. [70]	RC	Community	Adults admitted with community-acquired pneumonia	455	P vs. C	20	↑,*	↑	-,*
Rifkin et al. [106]	RC	Teaching	All patients admitted to GMS	11,388	F vs. C	18		-
Rifkin et al. [69]	RC	Community	All patients admitted with community-acquired pneumonia	158	F vs. C	11	↑,*
Roy et al. [30]	RC	Teaching	Adults admitted with hip fracture	118	F vs. C	9		↑,*
Roytman et al. [67]	RC	Teaching	Adults admitted with congestive heart failure	342	F vs. C	20	↑	↑	↑
Salottolo et al. [89]	B/A	Teaching	Adult trauma admissions	500	F vs. TWS	5		↓	-
Scheurer et al. [107]	RC	Mixed (29 sites)	All patients admitted with bacterial pneumonia	11,969	Mixed practice types	7		↑,*
Schneider et al. [53]	QE	Teaching (six sites)	All admissions to GMS with HIV infection	1,207	A vs. TWS	17	-	-	-
Sharma et al. [9]	RC	Mixed (11 sites)	Older adults on Medicaid with advanced lung cancer	21,183	Mixed practice types	14	↓
Simon et al. [84]	B/A	Paediatric teaching	Paediatric patients undergoing spinal fusion	759	F^b vs. TWS	8		↑
Sloan et al. [24]	B/A	Community VA	Adults admitted to inpatient psychiatric unit	1,409	F^c vs. C^c	18		-,*	↑,*
Smith et al. [71]	RC	Teaching	Adults admitted with community-acquired pneumonia	45	P vs. C	14	-	↓	-,*
Somekh et al. [59]	RC	Teaching	Admissions to GMS or cardiac observational unit for chest pain	750	F vs. C F vs. cardiologist	11	↑,* ↓,*	↓,ǂ ↓	- ↓
Southern et al. [108]	RC	Teaching	All patients admitted to GMS	9,037	A vs. TWS	19		↑	-
Srivastava et al. [64]	B/A	Paediatric teaching	Paediatric patients from one HMO admitted with asthma, dehydration or viral illness	1,970	A vs. TWS	19		↑
Stein et al. [73]	RC	Teaching	Adult admitted with community-acquired pneumonia	237	A vs. C	11	-,*	↑,*	-,*
Tenner et al. [57]	B/A	Paediatric teaching (two sites)	Paediatric admissions to ICU	1,211	P vs. TWS	17		↑	↑
Tingle and Lambert [109]	RC	Teaching	Adults admitted to GMS	529	F vs. TWS	14		-	-,*
Vasilevskis et al. [75]	RC	Teaching (six sites)	Adults with heart failure admitted to GMS	372	Mixed practice types	18	-	-	↑
Wachter et al. [55]	QE	Teaching	All patients admitted to GMS	1,623	A vs. TWS	18	-,*	↑	-
Wells et al. [110]	PC	Community	Paediatric patients admitted to GMS	181	P vs. C	5		↑	-,*

^aRCT, randomized, controlled trial; QE, quasi-experimental design; TS, time series; PC, prospective cohort; RC, retrospective cohort; B/A, before versus after; CS, cross-sectional survey; GMS, general medical service; HMO, health maintenance organization; UTI, urinary tract infection; COPD, chronic obstructive pulmonary disease; MI, myocardial infarction; HIV, human immunodeficiency virus; ICU, intensive care unit; P, private hospitalist attending physician; F, nonacademic faculty hospitalist attending physician; A, academic hospitalist attending physician; C, community-based physician; TWS, traditional academic attending physicians with teaching responsibilities; ^bhospitalists were comanaging their patients' care with comparison healthcare providers; ^cuse of physician's assistants, nurse practitioners and/or discharge planners in the provision of care; ↑ indicates improved performance by hospitalists; - indicates no difference in performance between providers; ↓ indicates worse performance by hospitalists; ǂ indicates that a P value or confidence interval was not provided, so results may or may not be statistically significant; *indicates that results are unadjusted.

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ISSN: 1741-7015

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