TY - JOUR
T1 - Quality of care for decompensated heart failure
T2 - Comparable performance between academic hospitalists and non-hospitalists
AU - Vasilevskis, Eduard E.
AU - Meltzer, David
AU - Schnipper, Jeffrey
AU - Kaboli, Peter
AU - Wetterneck, Tosha
AU - Gonzales, David
AU - Arora, Vineet
AU - Zhang, James
AU - Auerbach, Andrew D.
N1 - Funding Information:
Dr. Auerbach is supported by a K08 research and training grant (K080 HS11416-02) from the Agency for Healthcare Research and Quality. Dr. Kaboli is supported by a Research Career Development Award from the Health Services Research and Development Service, Department of Veterans Affairs (RCD 03-033-1). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Funding Information:
Dr. Wetterneck is supported by a Clinical Research Scholars Award from the National Institutes of Health (1 K12-RR01764-01). Data were presented at the Society of General Internal Medicine Annual Meeting on 26 April 2007.
Funding Information:
Acknowledgment: The authors would like to thank Eric Vittinghoff, PhD, for providing expert advice on the statistical methods used in this analysis. Funding for the Multicenter Hospitalist Study was supported by grant R01 HS10597 AHRQ from the Agency for Healthcare Research and Quality.
PY - 2008/9
Y1 - 2008/9
N2 - BACKGROUND: Hospitalists improve efficiency, but little information exists regarding whether they impact quality of care. OBJECTIVE: To determine hospitalists' effect on the quality of acute congestive heart failure care. DESIGN AND PARTICIPANTS: Using data from the Multicenter Hospitalist Study, we retrospectively evaluated quality of care in patients admitted with congestive heart failure who were assigned to hospitalists (n=120) or non-hospitalists (n=252) among six academic hospitals. MEASUREMENTS: Quality measures included the percentage of patients who had ejection fraction (EF) measurement, received appropriate medications [i.e., angiotensin-converting enzyme inhibitor (ACE-I) or beta-blockers] at discharge, measures of care coordination (e.g., follow-up within 30 days), testing for cardiac ischemia (e.g., cardiac catheterization), as well as hospital length of stay, cost, and combined 30-day readmissions and mortality. RESULTS: Compared to non-hospitalist physicians, hospitalists' patients had similar rates of EF measurement (85.3% vs. 87.5%; P=0.57), ACE-I (91.5% vs. 88.0%; P=0.52), or beta-blocker (46.9% vs. 42.1%; P=0.57) prescriptions. Multivariable adjustment did not change these findings. Hospitalists' patients had higher odds of 30-day follow-up (adjusted OR=1.83, 95% CI, 1.44 - 2.93). There were no significant differences between the groups' frequency of cardiac testing, length of stay, costs, or risk for readmission or death by 30-days. CONCLUSION: Academic hospitalists and non-hospitalists provide similar quality of care for heart failure patients, although hospitalists are paying more attention to longitudinal care. Future efforts to improve quality of care in decompensated heart failure may require attention towards system-level factors.
AB - BACKGROUND: Hospitalists improve efficiency, but little information exists regarding whether they impact quality of care. OBJECTIVE: To determine hospitalists' effect on the quality of acute congestive heart failure care. DESIGN AND PARTICIPANTS: Using data from the Multicenter Hospitalist Study, we retrospectively evaluated quality of care in patients admitted with congestive heart failure who were assigned to hospitalists (n=120) or non-hospitalists (n=252) among six academic hospitals. MEASUREMENTS: Quality measures included the percentage of patients who had ejection fraction (EF) measurement, received appropriate medications [i.e., angiotensin-converting enzyme inhibitor (ACE-I) or beta-blockers] at discharge, measures of care coordination (e.g., follow-up within 30 days), testing for cardiac ischemia (e.g., cardiac catheterization), as well as hospital length of stay, cost, and combined 30-day readmissions and mortality. RESULTS: Compared to non-hospitalist physicians, hospitalists' patients had similar rates of EF measurement (85.3% vs. 87.5%; P=0.57), ACE-I (91.5% vs. 88.0%; P=0.52), or beta-blocker (46.9% vs. 42.1%; P=0.57) prescriptions. Multivariable adjustment did not change these findings. Hospitalists' patients had higher odds of 30-day follow-up (adjusted OR=1.83, 95% CI, 1.44 - 2.93). There were no significant differences between the groups' frequency of cardiac testing, length of stay, costs, or risk for readmission or death by 30-days. CONCLUSION: Academic hospitalists and non-hospitalists provide similar quality of care for heart failure patients, although hospitalists are paying more attention to longitudinal care. Future efforts to improve quality of care in decompensated heart failure may require attention towards system-level factors.
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U2 - 10.1007/s11606-008-0680-3
DO - 10.1007/s11606-008-0680-3
M3 - Article
C2 - 18592321
AN - SCOPUS:50049121039
VL - 23
SP - 1399
EP - 1406
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 9
ER -