A Multicenter Trial of Academic Hospitalists

• the effects of hospitalists on housestaff and student education and satisfaction [ Time Frame: 1 academic year ] [ Designated as safety issue: No ]
  This will be accomplished by surveys administered to medical students and housestaff.
• quality of care for vulnerable elders [ Time Frame: 30 days after discharge ] [ Designated as safety issue: No ]
  chart abstraction tools in our project with questions aimed to address these issues

Care of hospitalized patients by "hospitalists" -- often defined as physicians who dedicate at least 25% of their practice to inpatient care -- is a recent, growing, and controversial trend in health care delivery in the United States. But despite the growth of interest in hospitalists, there have been few scientific evaluations of the concept. The comprehensive aim of this research study is to measure and analyze the effects of hospitalists on patient outcomes, costs and medical education on the general medical services of a group of academic centers.

In 2001, a study titled, "A Multi-Center Trial of Academic Hospitalists" began at the University of Chicago Hospital along with five additional academic institutions. The study is currently and successfully collecting data solely at the University of Chicago Medical Center with plans to collect data at Mercy Hospital in the near future.

The comprehensive aim of this proposed research is to measure and analyze the effects of hospitalists on patient outcomes, costs, and medical education on the general medicine services at Mercy Hospital and the University of Chicago Medical Center (UC). Additionally, this data will be used in addition to a group of six academic medical centers: Brigham and Women's Hospital (BWH), , the University of California-San Francisco (UCSF), the University of Chicago (UC), the University of Iowa (UI), the University of New Mexico (UNM), and the University of Wisconsin (UW) in which data has been collected between 2001-2003 (see UC-IRB#9967). The comprehensive aim of this research will be pursued through five specific aims:

Specific Aim #1- To assess whether hospitalists affect the cost and quality of inpatient care. This will be accomplished by analyzing the outcomes of 50,000 patients assigned to hospitalists or non-hospitalists using a quasi-randomized design based on day of the week of admission. Outcomes will include in-hospital and post-discharge mortality, readmission, emergency room use, and patient satisfaction.

Specific Aim #2- To assess the mechanisms by which hospitalists may effect the cost and quality of care. Understanding these mechanisms is essential if hospitalist programs are to be designed in ways that permit them to achieve their desired benefits. We will develop measures to assess the whether these possible mechanisms by which hospitalists may have their effects are related to costs and outcomes.

Specific Aim #3- To assess the effects of hospitalists on housestaff and student education and satisfaction. This will be accomplished by surveys administered to medical students and housestaff.

Specific Aim #4 - To attempt to quantify primary care providers' (PCP's) satisfaction with the frequency, promptness, manner, and content of communication with the in-hospital healthcare team, and to assess differences in PCP satisfaction with teams led by hospitalist and non-hospitalist attending physicians. We hypothesize that deficiencies in such communication may impair continuity of care with outpatient physicians during hospitalization and at the time of discharge, and may be improved when the attending physician is a hospitalist.

Specific Aim #5- To assess the quality of care for vulnerable elders for specific geriatric syndromes and diseases by modifying our current surveys and chart abstraction tools in our project with questions aimed to address these issues.

Inpatients admitted in General Medicine at the University of Chicago

• Karliner LS, Kim SE, Meltzer DO, Auerbach AD. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med. 2010 May-Jun;5(5):276-82.
• Hasan O, Meltzer DO, Shaykevich SA, Bell CM, Kaboli PJ, Auerbach AD, Wetterneck TB, Arora VM, Zhang J, Schnipper JL. Hospital readmission in general medicine patients: a prediction model. J Gen Intern Med. 2010 Mar;25(3):211-9. Epub 2009 Dec 15.
• Auerbach AD, Katz R, Pantilat SZ, Bernacki R, Schnipper J, Kaboli P, Wetterneck T, Gonzales D, Arora V, Zhang J, Meltzer D. Factors associated with discussion of care plans and code status at the time of hospital admission: results from the Multicenter Hospitalist Study. J Hosp Med. 2008 Nov-Dec;3(6):437-45.
• Vasilevskis EE, Meltzer D, Schnipper J, Kaboli P, Wetterneck T, Gonzales D, Arora V, Zhang J, Auerbach AD. Quality of care for decompensated heart failure: comparable performance between academic hospitalists and non-hospitalists. J Gen Intern Med. 2008 Sep;23(9):1399-406. Epub 2008 Jul 1.

Inclusion Criteria:

• General Medicine inpatients at the University of Chicago Hospital or Mercy Hospital in Chicago Illinois

Exclusion Criteria:

• Non-General Medicine inpatients