Quality of care for decompensated heart failure: Comparable performance between academic hospitalists and non-hospitalists

Eduard E. Vasilevskis, David Meltzer, Jeffrey Schnipper, Peter Kaboli, Tosha Wetterneck, David Gonzales, Vineet Arora, James Zhang, Andrew D. Auerbach

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1399-1406
Number of pages8
JournalJournal of General Internal Medicine
Volume23
Issue number9
DOIs
StatePublished - Sep 1 2008
Externally publishedYes

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All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Vasilevskis, E. E., Meltzer, D., Schnipper, J., Kaboli, P., Wetterneck, T., Gonzales, D., Arora, V., Zhang, J., & Auerbach, A. D. (2008). Quality of care for decompensated heart failure: Comparable performance between academic hospitalists and non-hospitalists. Journal of General Internal Medicine, 23(9), 1399-1406. https://doi.org/10.1007/s11606-008-0680-3