Proof of Concept


Published research on hospitalist quality, cost-effectiveness, and other outcomes, such as a recent study in Archives of Internal Medicine (2009;169(15):1389-1394) that shows hospitalists achieve higher scores on three quality-of-care measures, can provide ammunition for HM leaders trying to justify their programs’ worth to hospital administrators, says one HM group leader.

In the study, Lenny Lopez, MD, MPH, and colleagues at Massachusetts General Hospital examined Hospital Quality Alliance data from 3,619 hospitals, 40% of which had hospitalists. They compared composite measures of quality of care for acute myocardial infarction, congestive heart failure, and pneumonia, and found that scores were higher for the hospitals with hospitalist programs.

Such studies help shed light on the central questions of hospitalists’ value, says Julia Wright, MD, FHM, head of the hospital medicine section at the University of Wisconsin in Madison. Initially, the question was whether the hospitalist model was even viable, which Dr. Wright believes has been laid to rest. The next questions involved efficiency and bottom-line issues—such as length of stay—and a strong case has been made overall for HM’s cost-effectiveness, she says. Quality of care has been harder to demonstrate, but newer quality measures make it easier to report, Dr. Wright adds.

Dr. Wright says the Lopez study, which highlights hospitalists’ ability to conform to guidelines, will be valuable to hospitalist groups. “We do talk with our administration about these questions, although we focus more on alignment of goals and mission, occasionally citing articles like this,” she says. “More important is to be aware of the core quality issues and have metrics of our own.”

Then again, programs just starting out might find the research essential, she says.

“Hospitalists participate in any number of quality initiatives,” Dr. Wright adds. “A lot of their data could be published and added to the small library of research on hospital medicine’s contributions to quality.”

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