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.
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.
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|Singh, Siddhartha; Lin, Yu-Li; Nattinger, Ann B et al. (2015) Variation in readmission rates by emergency departments and emergency department providers caring for patients after discharge. J Hosp Med 10:705-10|
|Tan, Alai; Holmes, Holly M; Kuo, Yong-Fang et al. (2015) Coadministration of co-trimoxazole with sulfonylureas: hypoglycemia events and pattern of use. J Gerontol A Biol Sci Med Sci 70:247-54|
|Kuo, Yong-Fang; Goodwin, James S; Chen, Nai-Wei et al. (2015) Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians. J Am Geriatr Soc 63:1980-8|
|Kuo, Yong-Fang; Chen, Nai-Wei; Baillargeon, Jacques et al. (2015) Potentially Preventable Hospitalizations in Medicare Patients With Diabetes: A Comparison of Primary Care Provided by Nurse Practitioners Versus Physicians. Med Care 53:776-83|
|Lee, Jinhyung; Kuo, Yong-Fang; Lin, Yu-Li et al. (2015) The combined effect of the electronic health record and hospitalist care on length of stay. Am J Manag Care 21:e215-21|
|Boonyasai, Romsai T; Lin, Yu-Li; Brotman, Daniel J et al. (2015) Characteristics of primary care providers who adopted the hospitalist model from 2001 to 2009. J Hosp Med 10:75-82|
|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|
|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|
|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|
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