This represents a competitive renewal of an application to study the impact of hospitalists on the care of older hospitalized patients. We have used 5% national Medicare data to describe the growth of hospitalists from 1996 through 2006 to evaluate the association of care by hospitalists with length of stay;to assess how the impact of hospitalists on length of stay varies by patient and hospital characteristics, and disease severity;to examine how hospitalist care effects continuity of care during hospitalization and across the transition from community to hospital and back;to describe the growing role of hospitalists in caring for surgical patients;and to begin to describe the outcomes of hospitalist care. We have found evidence of cost shifting;that is, hospitalist care is associated with reduced hospital length of stay and costs but increased Medicare expenditures post discharge.
Our Specific Aims are: 1. Examine the association of care by hospitalists with processes and outcomes of care, focusing on quality indicators at the hospital level. Is adoption of a hospitalist model by a hospital accompanied by improvements in quality? 2. Examine the impact of adoption of an electronic medical record (EMR) system on hospitalist care. Does implementation of a complete EMR impact the relative advantage of hospitalists on length of stay? Does implementation of an EMR in a hospital system reduce or eliminate the association of hospitalist care with increased utilization and costs post discharge? 3. Explore the use of 100% Medicare data to assess performance of individual hospitalists. We will address these aims using the 5% national sample of Medicare charge data from 1995 through 2010, and 100% Medicare data from Texas for 2000-2010.

Public Health Relevance

Over the past 10 years patients hospitalized for medical illnesses are increasingly more likely to be cared for by full-time hospital physicians, termed hospitalists. We propose to study how care by hospitalists affects overall quality of care in a hospital. We also will use 100% Medicare data to describe variation among hospitalists in their performance;for example, in the percent of their patients who are readmitted to the hospital after discharge.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
Project #
Application #
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Baker, Colin S
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Texas Medical Br Galveston
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Parekh, Trisha M; Raji, Mukaila; Lin, Yu-Li et al. (2014) Hypoglycemia after antimicrobial drug prescription for older patients using sulfonylureas. JAMA Intern Med 174:1605-12
Singh, Siddhartha; Lin, Yu-Li; Kuo, Yong-Fang et al. (2014) Variation in the risk of readmission among hospitals: the relative contribution of patient, hospital and inpatient provider characteristics. J Gen Intern Med 29:572-8
Goodwin, James S; Lin, Yu-Li; Singh, Siddhartha et al. (2013) Variation in length of stay and outcomes among hospitalized patients attributable to hospitals and hospitalists. J Gen Intern Med 28:370-6
Kuo, Yong-Fang; Loresto Jr, Figaro L; Rounds, Linda R et al. (2013) States with the least restrictive regulations experienced the largest increase in patients seen by nurse practitioners. Health Aff (Millwood) 32:1236-43
Raji, Mukaila A; Lowery, Matthew; Lin, Yu-Li et al. (2013) National utilization patterns of warfarin use in older patients with atrial fibrillation: a population-based study of Medicare Part D beneficiaries. Ann Pharmacother 47:35-42
Fisher, Steve R; Kuo, Yong-Fang; Sharma, Gulshan et al. (2013) Mobility after hospital discharge as a marker for 30-day readmission. J Gerontol A Biol Sci Med Sci 68:805-10
Kuo, Yong-Fang; Raji, Mukaila A; Goodwin, James S (2013) Association between proportion of provider clinical effort in nursing homes and potentially avoidable hospitalizations and medical costs of nursing home residents. J Am Geriatr Soc 61:1750-7
Sharma, Gulshan; Wang, Yue; Graham, James E et al. (2013) Provider continuity prior to the diagnosis of advanced lung cancer and end-of-life care. PLoS One 8:e74690
Baillargeon, Jacques; Wang, Yue; Kuo, Yong-Fang et al. (2013) Temporal trends in hospitalization rates for older adults with chronic obstructive pulmonary disease. Am J Med 126:607-14
Goodwin, James S; Howrey, Bret; Zhang, Dong D et al. (2011) Risk of continued institutionalization after hospitalization in older adults. J Gerontol A Biol Sci Med Sci 66:1321-7

Showing the most recent 10 out of 19 publications