Starting in the 1990's, some physicians began to devote all of their time to the care of hospitalized patients. They are referred to as hospitalists. Our preliminary data suggest a rapid growth in the number of hospitalized older patients cared for nationally by hospitalists, from 6.4% in 1995 to 36.3% in 2005. In some areas the majority of inpatients now receive their care from hospitalists. Most of these patients were at community, non- teaching hospitals. To a large extent, this rapid growth and its effect on hospital care has gone unexamined. Almost all prior studies of the hospitalist model have been at single institutions, usually academic medical centers. These studies, including several prospective trials, suggest that hospitalist care is associated with shorter length of stay and lower hospital costs, with no differences in outcomes (usually assessed as hospital or 30 day mortality). However, there have been no national or population-based studies assessing the growth of hospitalists and their impact on the processes and outcomes of hospital care. In particular, it is not at all clear that the results of trials in an academic hospital are generalizable to non-teaching hospitals.
Our Specific Aims are: 1. Describe the patterns of growth of hospitalist care in the US from 1995 through 2008. 2. Investigate the effect of hospitalist care on length of stay and hospital and professional charges and assess whether the effect varies by hospital, patient or hospitalist characteristics. 3. Evaluate the effect of hospitalists on general and key diagnosis-specific processes of care and whether these vary by characteristics of the patient, hospital, and hospitalist. 4. Evaluate the impact of hospitalists on outcomes of care, and whether these vary by diagnosis, other patient characteristics, type of hospital, and characteristics of the hospitalist. We will address these aims using a 5% national sample of Medicare charge data from 1995 through 2008. 1

Public Health Relevance

The last 20 years has seen a steep rise in the number of older patients cared for in hospitals by hospitalists, that is, physicians who devote all their time to care of hospitalized patients. Using Medicare and other data, we will characterize the growth in hospitalist care from 1995-2008, and look at key indicators to evaluate the impact of hospitalists on processes and outcomes of care.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG033134-02
Application #
7926964
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Baker, Colin S
Project Start
2009-09-15
Project End
2011-08-31
Budget Start
2010-09-01
Budget End
2011-08-31
Support Year
2
Fiscal Year
2010
Total Cost
$310,665
Indirect Cost
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
Li, Shuang; Middleton, Addie; Ottenbacher, Kenneth J et al. (2018) Trajectories Over the First Year of Long-Term Care Nursing Home Residence. J Am Med Dir Assoc 19:333-341
Middleton, Addie; Downer, Brian; Haas, Allen et al. (2018) Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Skilled Nursing Facility Discharge Among Medicare Beneficiaries. J Am Med Dir Assoc 19:348-354.e4
Goodwin, James S; Salameh, Habeeb; Zhou, Jie et al. (2018) Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population. JAMA Intern Med 178:196-203
Hong, Ickpyo; Karmarkar, Amol; Chan, Winston et al. (2018) Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going From Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation. Am J Phys Med Rehabil 97:636-645
Goodwin, James S; Li, Shuang; Middleton, Addie et al. (2018) Differences Between Skilled Nursing Facilities in Risk of Subsequent Long-Term Care Placement. J Am Geriatr Soc 66:1880-1886
Raji, Mukaila A; Kuo, Yong-Fang; Adhikari, Deepak et al. (2018) Decline in opioid prescribing after federal rescheduling of hydrocodone products. Pharmacoepidemiol Drug Saf 27:513-519
Middleton, Addie; Kuo, Yong-Fang; Graham, James E et al. (2018) Readmission Patterns Over 90-Day Episodes of Care Among Medicare Fee-for-Service Beneficiaries Discharged to Post-acute Care. J Am Med Dir Assoc 19:896-901
Middleton, Addie; Li, Shuang; Kuo, Yong-Fang et al. (2018) New Institutionalization in Long-Term Care After Hospital Discharge to Skilled Nursing Facility. J Am Geriatr Soc 66:56-63
Makam, Anil N; Nguyen, Oanh Kieu; Xuan, Lei et al. (2018) Factors Associated With Variation in Long-term Acute Care Hospital vs Skilled Nursing Facility Use Among Hospitalized Older Adults. JAMA Intern Med 178:399-405
Goodwin, James S; Li, Shuang; Zhou, Jie et al. (2017) Comparison of methods to identify long term care nursing home residence with administrative data. BMC Health Serv Res 17:376

Showing the most recent 10 out of 43 publications