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May 4, 2011

Hospitalist Efforts and Improving Discharge Planning

JAMA. 2011;305(17):1766-1767. doi:10.1001/jama.2011.562

To the Editor: Drs Mor and Besdine1 conveyed many of the causes of the dysfunctional hospital discharge process. They identified payment, organization, and accountability as major drivers of this problem. However, we disagree with the authors' comments on the contribution of hospitalists.

Hospitalist growth over the last decade has been substantial, with the percentage of internal medicine physicians identified as hospitalists increasing from 5.9% in 1995 to 19.0% in 2006, with more than 30 000 currently practicing.2 As documented by a systematic review including studies dating to the 1970s (prehospitalist), communication between the hospital and outpatient physician has been a chronic problem and not a new issue that evolved with hospitalists.3 Mor and Besdine wrote that, “ . . . evidence suggests that the hospitalist movement has reduced hospital stays and improved inpatient quality indicators without clear deleterious effects on patient outcomes,” yet they suggest hospitalists may serve as a source of problems with discharge transitions.

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