Neglect of the inpatient: the hospitalist movement in Canada responds

Characteristics of the ideal hospitalist inpatient care program: perceptions of Canadian health system leaders

Background

Despite the growing prevalence of hospitalist programs in Canada, it is not clear what program features are deemed desirable by administrative and medical leaders who oversee them. We aimed to understand perceptions of a wide range of healthcare administrators and frontline providers about the implementation and necessary characteristics of a hospitalist service.

Methods

We conducted semi-structured interviews with a range of administrators, medical leaders and frontline providers across three hospital sites operated by an integrated health system in British Columbia, Canada.

Results

Most interviewees identified the hospitalist model as the ideal inpatient care service line, but identified a number of challenges. Interviewees identified the necessary features of an ideal hospitalist service to include considerations for program design, care and non-clinical processes, and alignment between workload and physician staffing. They also identified continuity of care as an important challenge, and underlined the importance of communication as an important enabler of implementation of a new hospitalist service.

Conclusions

Most hospital administrators and frontline providers in our study believed the hospitalist model resulted in improvements in clinical processes and work environment.

Does implementation of a hospitalist program in a Canadian community hospital improve measures of quality of care and utilization? an observational comparative analysis of hospitalists vs. traditional care providers

Background

Despite the growth of hospitalist programs in Canada, little is known about their effectiveness for improving quality of care and use of scarce healthcare resources. The objective of this study is to compare measures of cost and quality of care (in-hospital mortality, 30-day same-facility readmission, and length of stay) of hospitalists vs. traditional physician providers in a large Canadian community hospital setting.

Methods

We performed a retrospective analysis of data from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database, using multivariate logistic and linear regression analyses comparing performance of four provider groups of traditional family physicians (FPs), traditional internal medicine subspecialists (other-IM), family physician-trained hospitalists (FP-Hospitalist), and general internal medicine-trained hospitalists (GIM-Hospitalist).

Results

Compared to traditional FPs, FP-Hospitalists and GIM-Hospitalists demonstrate lower mortality [OR 0.881, (CI 0.779 – 0.996); and OR 0.355, (CI 0.288 – 0.436)] and readmission rates [OR 0.766, (CI 0.678 – 0.867); and OR 0.800, (CI 0.675 – 0.948)]. Compared to traditional FPs, GIM-Hospitalists appear to improve length of stay [OR−2.975, (CI −3.302 – -2.647)] while FP-Hospitalists perform similarly [OR 0.096, (CI −0.136 – 0.329)]. Compared to other-IM, GIM-Hospitalists have similar performance on all measures while FP-Hospitalists show a mixed impact.

Conclusions

Compared to traditional family physicians, hospitalists appear to improve measures of quality and resource utilization. Specifically, hospitalists demonstrate lower in-hospital mortality and 30-day readmission rates while improving (or at least showing similar) length of stay. Compared to traditional subspecialists, hospitalists demonstrate similar performance despite looking after sicker and more complex medical patients.