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The Who, What, When, Where, Whom, and How of Hospitalist Care
- The Editors
Desires to improve inpatient care fueled the development of the hospitalist movement. To advocates of the movement, it seemed obvious that physicians who focused on hospital care would achieve better outcomes than physicians who spent most of their time in outpatient settings (1). Others, however, argued that hospitalists disrupted the continuum of care and would adversely affect clinical outcomes and patient satisfaction (2-4). Only research could resolve these disputes, and at least 19 observational studies have evaluated hospitalists' care (5). The studies, conducted mostly in academic settings with historical controls, small numbers of hospitalists, and selected patients, have generally found that hospitalist care was associated with important reductions in average length of stay and costs. Few studies tested for associations between hospitalists and clinical outcomes, and, among these studies, few found consistent relationships.
In this issue, two studies by Auerbach (6) and Meltzer (7) and colleagues corroborate past research and are the first to report that hospitalists' outcomes, including patient survival, improve as hospitalists gain experience. Given these results, is it time to recommend that hospitalists care for all hospitalized patients? In considering such a recommendation, we ask two difficult questions. First, does research show that important outcomes are substantively different and better in systems where hospitalists provide care? Second, if there are differences, are they due to the hospitalists or to something else?
The answer to the first question depends on the relative value that we place on patient-centered outcomes (symptoms, function, time to recovery, and mortality), physician-centered outcomes (career …
