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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG033134-05
Application #
8525288
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Baker, Colin S
Project Start
2008-12-01
Project End
2014-08-31
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
5
Fiscal Year
2013
Total Cost
$219,769
Indirect Cost
$71,060
Name
University of Texas Medical Br Galveston
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
800771149
City
Galveston
State
TX
Country
United States
Zip Code
77555
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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
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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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