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 #
5R01AG033134-04
Application #
8323269
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
2012-09-01
Budget End
2013-08-31
Support Year
4
Fiscal Year
2012
Total Cost
$293,034
Indirect Cost
$97,826
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
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
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
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

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