Invited commentaryHospitalists in children’s hospitals: What we know now and what we need to know
Section snippets
Background/overview
In the past 10 years, the use of hospitalists has grown in both the adult and pediatric setting as a response to pressure to deliver cost-effective, high-quality care.3 There were approximately 8000 hospitalists (adult and pediatric) in the United States in 2004.4 The hypothesized advantages of using hospitalists include that patients may receive better care because hospitalists specialize in handling acute or chronic illness and have become proficient in navigating the hospitals’
Research—data studies
There is a growing body of literature supporting the use of hospitalists, with most studies touting improved efficiency (reductions in LOS and total cost of care) without adversely impacting outcomes, quality of care, or satisfaction.3, 8, 17, 19
Research—opinion surveys
In addition to data studies, much of the available literature focuses on surveys of patients and physicians to ascertain their attitudes toward hospitalists.
Literature reviews
There were 15 literature reviews identified in our search that focused primarily on the impact of the hospitalist movement. Coffman and Rundall examined 21 articles about the impact of hospitalists (4 of the 21 were conducted in a pediatric setting).8 They report that “most of the evaluations found patients managed by hospitalists had lower total costs or charges primarily due to reduced LOS and most of the evaluations found no statistically significant differences in quality of care or
Case studies
These articles provide examples of the broader findings from previous sections. For example, Ogershok et al describe the restructuring of an inpatient pediatric ward using the hospitalist model and report that hospital costs per patient fell 13%.34 In another study, hospitalists managing inpatient care reduced commercial LOS to 3.8 days from 6.2 days and Medicare length of stay to 4.2 days from 7.1.35
Commentaries
These articles provide overviews of the hospitalist “movement” and offer comments on the various limitations of the existing studies. Because the focus of this review is on research that quantifies the impact of hospitalists, we have not included a detailed discussion of commentaries and recommend the accompanying literature review matrix for details.
Areas for further research
Because the literature surrounding the specific impact of pediatric hospitalists is still fairly limited, larger and more rigorous pediatric-focused studies must be performed to identify how pediatric hospitalists affect outcomes, costs, and satisfaction.3, 16 There is also a need for further research about the educational impact of hospitalists. A 2001 literature review by Landrigan et al specifies a detailed research agenda to further evaluate pediatric hospitalist systems.19
Other areas
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Supported by a grant from the American Board of Pediatrics Foundation.