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Controversies in Internal Medicine
June 23, 2008

A Hospitalist Inpatient System Does Not Improve Patient Care Outcomes

Author Affiliations

Author Affiliation:Department of Internal Medicine, University of Alabama, Birmingham.



Arch Intern Med. 2008;168(12):1257-1258. doi:10.1001/archinte.168.12.1257

What is a hospitalist inpatient system? How do we define improving patient care outcomes (PCOs)? To what alternative are we comparing a hospitalist inpatient system?

We have been asked to debate a proposition that raises many questions. I submit that per se a hospitalist inpatient system does not improve PCOs. I will base my argument on several major points.

First, hospitalist “systems” vary greatly among hospitals. We cannot evaluate hospitalist systems generically because of their great variation. Second, we must look at all outcomes. We cannot focus just on hospital outcomes; we must include long-term outcomes. The hospitalist model might have positive or negative effects on trust and satisfaction. Third, we must consider the relative importance of physician factors and system factors. We must include continuity factors—both in the hospital and across settings.