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

BACKGROUND: Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to de...

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Autores principales: White, Heather L, Glazier, Richard H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123228/
https://www.ncbi.nlm.nih.gov/pubmed/21592322
http://dx.doi.org/10.1186/1741-7015-9-58
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author White, Heather L
Glazier, Richard H
author_facet White, Heather L
Glazier, Richard H
author_sort White, Heather L
collection PubMed
description BACKGROUND: Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. METHODS: Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. RESULTS: The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37). CONCLUSIONS: Future research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality.
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spelling pubmed-31232282011-06-25 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 BMC Med Research Article BACKGROUND: Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. METHODS: Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. RESULTS: The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37). CONCLUSIONS: Future research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality. BioMed Central 2011-05-18 /pmc/articles/PMC3123228/ /pubmed/21592322 http://dx.doi.org/10.1186/1741-7015-9-58 Text en Copyright ©2011 White and Glazier; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
White, Heather L
Glazier, Richard H
Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures
title Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures
title_full Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures
title_fullStr Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures
title_full_unstemmed Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures
title_short Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures
title_sort do hospitalist physicians improve the quality of inpatient care delivery? a systematic review of process, efficiency and outcome measures
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123228/
https://www.ncbi.nlm.nih.gov/pubmed/21592322
http://dx.doi.org/10.1186/1741-7015-9-58
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