Author Affiliations: Department of Medicine, University of California, San Francisco.
Context We originally described the hospitalist model of inpatient care in 1996;
since then, the model has experienced tremendous growth. This growth has important
clinical, financial, educational, and policy implications.
Objectives To review data regarding the effect of hospitalists on resource use,
quality of care, satisfaction, and teaching; and to analyze the impact of
hospitalists on the health care system and frame key issues facing the movement.
Data Sources and Study Selection We searched MEDLINE, BIOSIS, EMBASE, and the Cochrane Library from 1996
to September 2001 for studies comparing hospitalist care with an appropriate
control group in terms of resource use, quality, or satisfaction outcomes.
Data Extraction We extracted information regarding study design, nature of hospitalist
and control groups, analytical strategies, and key outcomes.
Data Synthesis Most studies found that implementation of hospitalist programs was associated
with significant reductions in resource use, usually measured as hospital
costs (average decrease, 13.4%) or average length of stay (average decrease,
16.6%). The few studies that failed to demonstrate reductions usually used
atypical control groups. Although several studies found improved outcomes,
such as inpatient mortality and readmission rates, these results were inconsistent.
Patient satisfaction was generally preserved, while limited data supported
positive effects on teaching. Although concerns about inpatient-outpatient
information transfer remain, recent physician surveys indicate general acceptance
of the model.
Conclusions Empirical research supports the premise that hospitalists improve inpatient
efficiency without harmful effects on quality or patient satisfaction. Education
may be improved. In part catalyzed by these data, the clinical use of hospitalists
is growing rapidly, and hospitalists are also assuming prominent roles as
teachers, researchers, and quality leaders. The hospitalist field has now
achieved many of the attributes of traditional medical specialties and seems
destined to continue to grow.
Wachter RM, Goldman L. The Hospitalist Movement 5 Years Later. JAMA. 2002;287(4):487-494. doi:10.1001/jama.287.4.487