Hospitalist Care for Unplanned Oncology Admissions: A Mixed-Method Analysis of Oncology and General Hospitalist...

To compare patient outcomes across oncology hospitalist (OH) and general hospitalist (GH) teams and understand related team practices.

Using an explanatory sequential mixed-methods design, we compared unplanned inpatient admissions to the GH or OH teams at our academic medical center between 2018 and 2022 using propensity-score matching to balance characteristics across teams. Primary outcomes included outpatient oncology follow-up, 30-day readmission, and discharge to hospice. Outcomes were modeled with multivariable logistic regression, adjusted for age, race, and comorbidity. We conducted semi-structured interviews with OH (n = 6), GH (n = 7), and oncology consult team (n = 4) clinicians. Themes were identified through rapid qualitative analysis and consensus discussions between two qualitative researchers.

The matched sample included 1082 GH and 361 OH team admissions. Median length of stay was 5 days (IQR 3,8) for GH and 6 days for OH (IQR 4, 10) (p < 0.01). The OH team had higher adjusted odds of discharge to hospice (aOR: 1.9, 95% CI: 1.1-3.5), outpatient oncology follow-up within 30 days (aOR: 4.2, 95% CI: 3.1-5.6), but also 30-day readmissions (aOR: 1.8, 95% CI: 1.3-2.5) compared to the GH team. The OH team communicated directly with outpatient oncology throughout hospitalizations and sent discharge summaries with follow-up recommendations. In contrast, the GH team relied on the consulting oncology team to communicate with outpatient oncologists and had variable follow-up practices.

Engagement with outpatient oncologists throughout patient admissions may contribute to more effective discharge planning. Inpatient teams can use this strategy to help improve hospital transitions of care for patients with cancer.