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Pediatric hospitalist systems versus traditional models of care: effect on quality and cost outcomes
Grant M Mussman1, Patrick H Conway
1Division of General and Community Pediatrics, Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. grant.mussman@cchmc.org
Insights
Pediatric hospitalists may improve inpatient care quality and efficiency, though effects vary. Further research is needed to understand mechanisms and optimize hospital medicine systems for better pediatric care outcomes.
Area of Science:
- Pediatric hospital medicine
- Healthcare quality improvement
- Inpatient care systems
Background:
- Pediatric hospitalist systems are growing, but evidence on their impact on care quality is limited.
- Lack of established metrics hinders rigorous analysis of hospitalist system effectiveness.
Purpose of the Study:
- To evaluate the impact of pediatric hospitalists on key quality and outcome metrics.
- Assessed effects on length of stay, cost, patient satisfaction, mortality, readmission rates, and evidence-based medicine use.
Main Methods:
- Conducted a literature review of studies comparing pediatric hospitalists and traditional attending physicians.
- Performed a Medline search to identify relevant studies for analysis.
Main Results:
- Studies showed mixed results for length of stay, with some indicating reductions (6-14%) and others no significant difference.
- Readmission rates varied, with some studies reporting decreases for hospitalists and others no difference.
- Hospitalists reported higher adherence to evidence-based guidelines; patient satisfaction showed few differences; mortality data was insufficient.
Conclusions:
- Pediatric hospitalists show potential to enhance inpatient care quality and efficiency, but improvements are not consistently observed.
- Understanding the mechanisms driving these improvements is crucial.
- Recommendations include investing in comparative effectiveness research, developing pediatric quality measures, and focusing on quality delivery by hospital medicine groups.
Background:
Pediatric hospitalist systems are increasing in popularity, but data regarding the effects of hospitalist systems on the quality of care has been sparse, in part because rigorous metrics for analysis have not yet been established. We conducted a literature review of studies comparing the performance of pediatric hospitalists and traditional attendings.
Objective:
To determine the effect of pediatric hospitalists on quality and outcome metrics such as length of stay, cost, patient satisfaction, mortality, readmission rates, and use of evidence-based medicine during care.
Results:
A Medline literature search identified 11 studies that met criteria for inclusion. Five previously reviewed studies reported lengths of stay between 6% and 14% shorter for hospitalists. Five of the new studies evaluated lengths of stay, with 1 showing significantly lower length of stay and cost for a faculty model, 1 showing lower length of stay for hospitalists for all conditions, 1 for certain conditions only, and 2 showing no statistical difference. Six studies reported on readmission rate, with 4 showing no difference, 1 showing decreased readmissions for hospitalists, and 1 showing decreased readmissions for a traditional faculty service. Hospitalists self-report higher use of evidence-based guidelines. Few differences in patient satisfaction were reported. Mortality on the pediatrics wards is rare, and no studies were adequately powered to evaluate mortality rate.
Conclusion:
Hospitalists can improve the quality and efficiency of inpatient care in the pediatric population, but the effect is not universal, and mechanisms underlying demonstrated improvements are poorly understood. We propose 4 components to improve quality and value in hospital medicine systems: investment in comparative effectiveness research involving delivery system interventions, development and implementation of pediatric quality measures, better understanding of improvement mechanisms for hospital medicine systems, and increased focus on quality and value delivered by hospital medicine groups and individuals.
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