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16 February 1999 | Volume 130 Issue 4 Part 2 | Pages 355-359
This paper presents preliminary quality and utilization data from a hospitalist system that is being implemented at Kaiser Permanente, a large health maintenance organization with 16 hospitals in northern California. Hospitalist programs, which are staffed by clinicians highly skilled in caring for inpatients, are being launched with the aim of delivering high-quality, efficient medical care in an increasingly competitive health care delivery environment. This paper also describes, in some detail, the process of implementation at one hospital. Challenges to implementation included 1) overcoming the reluctance of clinic physicians to relinquish inpatient care responsibilities, 2) developing sustainable work schedules, 3) creating effective channels of communication between staff in inpatient and outpatient settings, and 4) designing appropriate compensation scales for hospitalists. Mean length of stay, patient-day rates, admission rates, consultation request rates, costs, and readmission rates were examined for patients discharged from adult medicine services at all 16 hospitals between 1 January 1994 and 30 June 1997. These preliminary resource utilization data seem promising, but further analysis is needed to assess how hospitalist programs may affect clinical quality of care, costs, and patient and provider satisfaction.
Author and Article Information
From the Kaiser Permanente Medical Center, Santa Clara, California; and The Permanente Medical Group, Oakland, California.
Drs. Craig, Hartka, and Likosky are equally responsible co-principal authors.
Acknowledgments: The authors thank all of the hospital-based specialists at Kaiser Permanente Northern California, whose dedication has made the program a reality. They also thank Patricia Kipnis, PhD, for statistical advice, and the Medical Editing Department at the Kaiser Foundation Research Institute for editorial assistance.
Grant Support: This project was internally funded.
Requests for Reprints: William H. Likosky, MD, The Permanente Medical Group, Department of Quality and Utilization, 1800 Harrison Street, Suite 410, Oakland, CA 94612; e-mail, bill.likosky{at}ncal.kaiperm.org.
Current Author Addresses: Dr. Craig: Department of Medicine, Kaiser Permanente Medical Center, 900 Kiely Boulevard, Santa Clara, CA 95051.
Dr. Hartka: Market Analysis and Planning, Kaiser Foundation Health Plan, Inc., One Kaiser Plaza, 25L, Oakland, CA 94612.
Dr. Likosky and Mr. Litsky: The Permanente Medical Group, Department of Quality and Utilization, 1800 Harrison Street, Suite 410, Oakland, CA 94612.
Dr. Caplan: Operations Development, The Permanente Medical Group, 1950 Franklin Street, 19th Floor, Oakland, CA 94612.
Ms. Smithey: Operations Support Services, The Permanente Medical Group, 1800 Harrison Street, Suite 430, Oakland, CA 94612. HOSPITALISTS AND HOSPITALIST SYSTEMS
Implementation of a Hospitalist System in a Large Health Maintenance Organization: The Kaiser Permanente Experience
Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled " The Hospitalist Movement in the United States." To see a complete list of the articles included in this supplement, please view its Table of Contents.
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