Cross-sectional analysis of hospitalist prevalence and quality of care in California

BACKGROUND: Hospital leaders usually provide financial support to hospitalists groups, often with an expectation of improved performance on publicly reported quality metrics. Whether the presence of hospitalists is associated with differences in hospital-level performance is unknown. OBJECTIVE: Assess the relationship between hospitalist prevalence and quality performance. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 208 California hospitals participating in a voluntary reporting initiative. INTERVENTION: Survey of hospital personnel with knowledge of the utilization of hospitalists for patient care. MEASUREMENTS: Sixteen publicly reported quality process measures across 3 medical conditions: acute myocardial infarction (AMI); congestive heart failure (CHF); and pneumonia. Using multivariable models, we assessed the relationship between the presence of hospitalists and the percentage of missed quality opportunities for each process measure. RESULTS: Of 208 eligible hospitals, 170 (82%) had hospitalist services. After adjustment, hospitals with hospitalists had similar performance for cardiac and pneumonia measures assessed at admission and fewer missed processes for CHF measures assessed at discharge. Among sites with hospitalists, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P < 0.001) missed quality opportunities for AMI at admission, and 0.6% (P < 0.001), 0.5% (P = 0.004), and 1.5% (P = 0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively. CONCLUSIONS: The presence of hospitalists in California was associated with modest improvements in performance on publicly reported process measures. Whether hospitalists directly improve quality or simply reflect a hospital's level of investment in quality remains a subject for future study.