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

Robb D Kociol; Bradley G Hammill; Gregg C Fonarow; Paul A Heidenreich; Alan S Go; Eric D Peterson; Lesley H Curtis; Adrian F Hernandez

doi:10.1016/j.jchf.2013.07.001

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

JACC Heart Fail. 2013 Oct;1(5):445-53. doi: 10.1016/j.jchf.2013.07.001. Epub 2013 Sep 11.

Authors

Robb D Kociol¹, Bradley G Hammill², Gregg C Fonarow³, Paul A Heidenreich⁴, Alan S Go⁵, Eric D Peterson⁶, Lesley H Curtis⁶, Adrian F Hernandez⁶

Affiliations

¹ CardioVascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: rkociol@bidmc.harvard.edu.
² Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
³ Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California.
⁴ Division of Cardiology, Department of Medicine, Palo Alto Veterans Affairs Medical Center, Stanford University School of Medicine, Palo Alto, California.
⁵ Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Epidemiology and Biostatistics and Medicine, University of California, San Francisco.
⁶ CardioVascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.

PMID: 24621978
DOI: 10.1016/j.jchf.2013.07.001

Abstract

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.

Keywords: Medicare; heart failure; hospitalists; outcome assessment (health care).

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cardiology*
Female
Guideline Adherence*
Heart Failure / therapy*
Hospitalists*
Hospitalization
Humans
Male
Medicare
Models, Theoretical*
Patient Outcome Assessment*
Quality of Health Care*
Retrospective Studies
United States