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Establishing a pediatric hospitalist program at an Academic Medical Center
K Ponitz1, J Mortimer, B Berman
1Department of Pediatrics, Rainbow Babies & Childrens Hospital, Case Western Reserve University, Cleveland, Ohio 44106-6019, USA.
Insights
A pediatric hospitalist program, established in 1993, proved feasible for academic medical centers. This program improved access for community physicians and supported general pediatrics.
Area of Science:
- Pediatric hospital medicine
- Academic medical centers
- Healthcare delivery systems
Background:
- Academic medical centers face increasing competition and evolving healthcare landscapes.
- The Pediatric Consultation and Referral Service (PCRS) was created to offer rapid access for pediatric referrals requiring urgent hospitalization.
- A pediatric hospitalist program was implemented to address these challenges.
Purpose of the Study:
- To describe the initial 3-year experience in planning, implementing, and evaluating a pediatric hospitalist program.
- To assess the feasibility and impact of a pediatric hospitalist program within an academic medical center.
- To evaluate physician perceptions of access, collegiality, and quality of care.
Main Methods:
- The Pediatric Consultation and Referral Service (PCRS) was established in 1993.
- Data collected over the first 3 years included patient demographics, diagnoses, and payer mix.
- Surveys were administered to referring physicians, pediatric residents, and subspecialty colleagues.
Main Results:
- PCRS cared for 2,740 patients in its first 3 years, with 63% under age 3.
- Common diagnoses included asthma, pneumonia, and bronchiolitis.
- Referring physicians and residents reported highly favorable perceptions of access, collegiality, and quality of care, while subspecialists rated quality lower.
Conclusions:
- A pediatric hospitalist program is logistically and economically feasible for academic medical centers.
- Such programs can enhance patient care, education, and research missions.
- Effective programs improve community physician access, foster collegial relationships, and promote general pediatrics as a career.
Abstract:
Academic medical centers have been challenged to respond to a rapidly changing and increasingly competitive health care environment. The Pediatric Consultation and Referral Service (PCRS) at Rainbow Babies & Children's Hospital (RB&C)/University Hospitals of Cleveland was established in 1993 with the goal of providing rapid access to community-based physicians for the referral of patients requiring urgent hospitalization within the broad scope of general pediatrics. We describe our initial 3-year experience in the planning, implementation, and evaluation of a pediatric hospitalist program. PCRS provided care to 2,740 patients during the first 3 years of operation, 63% (1,716) of whom were under age 3 years. Leading primary diagnoses in order of decreasing frequency were asthma, pneumonia, bronchiolitis, febrile illness, gastroenteritis, seizures, croup, apnea, and cellulitis. Third-party payer mix was: Medicaid 42%, managed care 42%, indemnity insurance 10%, self-pay 6%, and Bureau for Children with Medical Handicaps 1%. From survey data, referring physicians and pediatric residents assessed perceptions of access, collegiality, and quality of care in a highly favorable manner. Subspecialty colleagues perceived access and collegiality very favorably but rated quality of care substantially lower than referring physicians and residents did. Our experience demonstrates that a pediatric hospitalist program is logistically and economically feasible and may contribute to the patient care, education, and research missions of academic medical centers. A well-structured program can provide community physicians with excellent access and support collegial relationships. Beyond increasing a medical center's patient referral base, a hospitalist program can potentially enhance the esteem of the discipline of general pediatrics and, it is hoped, promote general pediatrics as a viable career option for trainees.