Author Affiliations: Department of Medicine, University of California, San Francisco, Greenbrae.
We thank Levin and Glasheen for their letter. We agree that our chosen quality and safety measures did not include several care processes or complications potentially affected by hospitalists' involvement. However, we would expect that such complications would have led to higher costs of care and potentially even higher risks of mortality and readmissions. Because we observed significantly lower costs and no change in mortality or readmission rate, we believe that it is unlikely that our study completely missed identifying a strong underlying impact on an important care process or complication.1
Auerbach AD, Berger MS, Wachter RM. Achieving Comanagment’s Potential Requires System Redesign and Hospitalist-Focused Training—Reply. Arch Intern Med. 2011;171(14):1299-1300. doi:10.1001/archinternmed.2011.324