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Pediatric hospitalists: a systematic review of the literature
Christopher P Landrigan1, Patrick H Conway, Sarah Edwards
1Department of Medicine, Children's Hospital Boston, MA 02115, USA. christopher.landrigan@childrens.harvard.edu
Insights
Pediatric hospitalist systems reduce hospital costs and length of stay. While provider and patient experiences are generally positive, the quality of care needs further investigation with rigorous metrics.
Area of Science:
- Healthcare Management
- Pediatric Hospital Medicine
- Health Services Research
Background:
- Systematic reviews show reduced length of stay and costs with internal medicine hospitalist systems.
- No systematic reviews have previously assessed pediatric hospitalist systems.
Purpose of the Study:
- To evaluate the impact of pediatric hospitalist systems on key healthcare metrics.
- To assess effects on length of stay, costs, quality of care, and provider satisfaction.
Main Methods:
- Comprehensive literature search of PubMed, Medline, Cochrane Library, and conference abstracts.
- Inclusion of primary-data studies on efficiency, financial performance, clinical outcomes, and patient/provider experience.
- Contacting authors to acquire unpublished study data to mitigate publication bias.
Main Results:
- Six of seven studies showed improved costs and/or length of stay in pediatric hospitalist systems (average 10% decrease each).
- Economic analyses indicate hospitalist programs often incur losses despite efficiency gains.
- Surveys suggest neutral or improved experiences for families, referring providers, and residents, though data are limited.
Conclusions:
- Pediatric hospitalist systems appear to decrease costs and length of stay without negative impacts on experiences.
- The quality of care remains uncertain due to a lack of rigorous evaluation metrics.
- Further research is needed on the processes and outcomes of pediatric hospital care.
Background:
Systematic reviews have demonstrated consistently decreased length of stay and costs in internal medicine hospitalist systems. Systematic reviews of pediatric hospitalist systems have not been conducted.
Objective:
Our aim was to determine the effects of pediatric hospitalist systems on length of stay, costs, quality of care, and provider satisfaction and experience.
Methods:
We searched PubMed, Medline, Cochrane Library databases, and the Pediatric Academic Societies National Meeting research abstracts for all primary-data studies published or presented on pediatric hospitalist systems. Studies presenting primary data on efficiency, financial performance, clinical outcomes, or family, referring provider, and housestaff experience in hospitalist systems were included; review articles and case studies were excluded. To minimize publication bias, we contacted all primary authors to obtain information about unpublished studies.
Results:
Of 47 publications reviewed, 20 were primary-data studies that met criteria for inclusion. Six of 7 studies that compared traditional and hospitalist systems of care demonstrated improvements in costs and/or length of stay in pediatric hospitalist systems. The average decrease in cost was 10%; average decrease in length of stay was 10%. Three of 3 economic analyses, however, demonstrate that efficiency gains do not generally translate into revenues for the hospitalist programs themselves; most hospitalist programs are currently losing money. Surveys of families, referring providers, and pediatric residents demonstrate neutral or improved experiences in hospitalist systems, although these data are less comprehensive. Data on quality of care are insufficient to draw conclusions.
Conclusions:
Emerging research suggests that pediatric hospitalist systems decrease hospital costs and length of stay without adversely affecting provider, parent, or housestaff experiences. The quality of care in pediatric hospitalist systems is unclear, because rigorous metrics to evaluate quality are lacking. Studies of the processes and outcomes of hospital care are needed.
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