Evaluating the Impact of Hospitalists

16 February 1999 | Volume 130 Issue 4 Part 2 | Pages 376-381

The hospital-based generalist physician is a recent organizational innovation in health care in the United States. Does the hospitalist model provide improved health care? The answer to this question lies in a rigorous evaluation of the hospitalist system in the clinical setting. This paper describes key outcomes that need to be assessed and methodologic issues that need to be addressed when conducting and interpreting the results of evaluations of the hospitalist model. To provide evidence about the value of the hospitalist model, quality of care should be evaluated through the measurement of both processes and outcomes. The clinical processes assessed may include diagnostic tests and treatments that are causally linked with outcomes. A variety of outcomes can be measured, such as death, clinical or physiologic status, physical function, and psychological well-being. The analysis of resource use data can aid in an assessment of the relative costs and effectiveness of clinical services. An evaluation of the hospitalist model requires an adequate research design, which should include a precise definition of the model being studied, the selection of an appropriate comparison group, the collection of clinical and demographic information on patients, the specification of both process and outcome measures, and the use of statistical techniques that are appropriate to the questions being asked and the data being collected. The design must distinguish between outcomes attributable to the introduction of hospitalists and those attributable to other changes in medical treatments and the organization of care.

Author and Article Information

From the University of California, San Francisco, San Francisco, California.
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.

Requests for Reprints: Jonathan Showstack, PhD, Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94143-0936; e-mail, jas1{at}itsa.ucsf.edu.

Current Author Addresses: Drs. Showstack and Katz: Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94143.

Dr. Weber: Division of Emergency Medicine, University of California, San Francisco, Campus Box 0208, San Francisco, CA 94143-0208.