Associations between use of the hospitalist model and quality of care and outcomes of older patients hospitalized for heart failure.

Published

Journal Article

OBJECTIVES: This study sought to examine the associations of hospitalist and cardiologist care of patients with heart failure with outcomes and adherence to quality measures. BACKGROUND: The hospitalist model of inpatient care has grown nationally, but its associations with quality of care and outcomes of patients hospitalized with heart failure are not known. METHODS: We analyzed data from the Get With the Guidelines-Heart Failure registry linked to Medicare claims for 2005 through 2008. For each hospital, we calculated the percentage of heart failure hospitalizations for which a hospitalist was the attending physician. We examined outcomes and care quality for patients stratified by rates of hospitalist use. Using multivariable models, we estimated associations between hospital-level use of hospitalists and cardiologists and 30-day risk-adjusted outcomes and adherence to measures of quality care. RESULTS: The analysis included 31,505 Medicare beneficiaries in 166 hospitals. Across hospitals, the use of hospitalists varied from 0% to 83%. After multivariable adjustment, a 10% increase in the use of hospitalists was associated with a slight increase in mortality (risk ratio: 1.03; 95% confidence interval [CI]: 1.00 to 1.06) and decrease in length of stay (0.09 days; 95% CI: 0.02 to 0.16). There was no association with 30-day readmission. Increased use of hospitalists in hospitals with high use of cardiologists was associated with improved defect-free adherence to a composite of heart failure performance measures (risk ratio: 1.03; 95% CI: 1.01 to 1.06). CONCLUSIONS: Hospitalist care varied significantly across hospitals for heart failure admissions and was not associated with improved 30-day outcomes. Comanagement by hospitalists and cardiologists may help to improve adherence to some quality measures, but it remains unclear what care model improves 30-day clinical outcomes.

Full Text

Duke Authors

Cited Authors

  • Kociol, RD; Hammill, BG; Fonarow, GC; Heidenreich, PA; Go, AS; Peterson, ED; Curtis, LH; Hernandez, AF

Published Date

  • October 2013

Published In

Volume / Issue

  • 1 / 5

Start / End Page

  • 445 - 453

PubMed ID

  • 24621978

Pubmed Central ID

  • 24621978

Electronic International Standard Serial Number (EISSN)

  • 2213-1787

International Standard Serial Number (ISSN)

  • 2213-1779

Digital Object Identifier (DOI)

  • 10.1016/j.jchf.2013.07.001

Language

  • eng