The Effect of Hospitalists on Average Length of Stay

Efficiency of the Japanese Hospitalist System for Patients with Urinary Tract Infection: A Propensity-matched Analysis

Objective The hospitalist system in the United States has been considered successful in terms of the quality of care and cost effectiveness. In Japan, however, its efficacy has not yet been extensively examined. This study examined the impact of the hospitalist system on the quality of care and healthcare economics in a Japanese population using treatment of urinary tract infection as an example. Methods We analyzed 271 patients whose most resource-consuming diagnosis at admission was urinary tract infection between April 2017 and March 2019. Propensity-matched analyses were performed to compare health care economics and the quality of care between the hospitalist system and the conventional system. Results In matched pairs, care by the hospitalist system was associated with a significantly shorter length of stay than that by the conventional system. The quality of care (oral antibiotics switch rate, rate of appropriate antibiotics change based on urine or blood culture results, detection rate of urinary tract infection etiology and the number of laboratory tests) was also considered to be favorably impacted by the hospitalist system. Although not statistically significant, hospital costs tended to be lower with the hospitalist system than with the conventional system. The mortality rate and 30-day readmission were also not significantly different between the groups. Conclusion The hospitalist system had a favorable impact on the quality of care and length of stay without increasing readmission in patients with urinary tract infection. This study is further evidence of the strong potential for the positive impact of an implemented hospitalist system in Japan.

Hospital Accreditation: A Review of Evidence, Regulatory Compliance, and Healthcare Outcome Measures

<b><i>Background:</i></b> Hospitals are increasingly under pressure to provide safe and high-quality care at an affordable cost. In response to this challenge, many have adopted accreditation as an internationally recognized tool to facilitate improvements in healthcare quality and patient safety. The objectives of the study were to (a) evaluate the impact of international hospital accreditation in Dubai and (b) inform policy decision-making. <b><i>Methods:</i></b> We adopted a literature review, analysis of violation data, and clinical performance measures. <b><i>Results:</i></b> The literature review suggests insufficient evidence to link accreditation to healthcare outcomes. We report a gradual increase in hospital violations and an improvement of clinical outcomes over three years, however the improvement in clinical outcome measures were not statistically significant. <b><i>Conclusions:</i></b> There is limited evidence to determine the impact of international hospital accreditation. Performance measures for accreditation are needed to validate the contribution accreditation may have on reducing non-compliance and improving clinical performance measures. Further research is needed to explore how well accreditation models fit within the Donabedian framework for healthcare quality.

Comparisons of Clinical Outcomes between Weekday-Only and Full-Time, 24-Hour/7-Day Coverage Hospitalist Systems

BACKGROUND

Since the launch of pilot programs in 2016, varying ranges of hospitalist coverage exist in Korea. We evaluated the effects of differing depths of hospitalist coverage on clinical outcomes.

METHODS

This study retrospectively reviewed the records of 513 patients admitted to a medical hospitalist unit through emergency department at Seoul National University Hospital. The full-time group included patients admitted in 2018 who received 24/7 hospitalist service, whereas the weekday group included patients admitted in 2019 with only weekday hospitalist service. In-hospital clinical outcomes were compared between the two groups.

RESULTS

Unplanned intensive care unit admission rate was lower in the full-time group than in the weekday group (0.4% vs. 2.9%; P = 0.042). Discharges to local hospitals for subacute or chronic care were more frequent in the full-time group than in the weekday group (12.6% vs. 5.8%; P = 0.007). The weekday coverage was a predictive factor of in-ward mortality (odds ratio, 2.00; 95% confidence interval, 1.01-3.99) after adjusting for potential confounding factors.

CONCLUSION

Uninterrupted weekend coverage hospitalist service is helpful for care-plan decision and timely care transitions for acutely and severely ill patients.