From the Journal of the American Medical AssociationThe Hospitalist Movement 5 Years Later
Robert M.Wachter,MD;Lee Goldman,MD,MPH
We originally described the hospitalist model of inpatient care in 1996; since then, the model has experienced tremendous growth.This growth has important clinical, financial, educational and policy implications.
To review data regarding the effect of hospitalists on resource use, quality of care, satisfaction, and teaching; and to analyze the impact of hospitalists on the health care system and frame key issues facing the movement.
Data Sources and Study Selection
We searched MEDLINE, BIOSIS, EMBASE, and the Cochrane Library from 1996 to September 2001 for studies comparing hospitalist care with an appropriate control group in terms of resource use, quality, or satisfaction outcomes.
We extracted information regarding study design, nature of hospitalist and control groups, analytical strategies and key outcomes.
Most studies found that implementation of hospitalist programs was associated with significant reductions in resource use, usually measured as hospital costs (average decrease, 13.4%) or average length of stay (average decrease, 16.6%).The few studies that failed to demonstrate reductions usually used atypical control groups.Although several studies found improved outcomes, such as inpatient mortality and readmission rates, these results were inconsistent.Patient satisfaction was generally preserved, while limited data supported positive effects on teaching. Although concerns about inpatient-outpatient information transfer remain, recent physician surveys indicate general acceptance of the model.
Empirical research supports the premise that hospitalists improve inpatient efficiency without harmful effects on quality or patient satisfaction. Education may be improved. In part catalyzed by these data, the clinical use of hospitalists is growing rapidly, and hospitalists are also assuming prominent roles as teachers, researchers, and quality leaders.The hospitalist field has now achieved many of the attributes of traditional medical specialties and seems destined to continue to grow.
JAMA, Vol.287 No.4, January 23/30,2002
From the British Medical JournalGetting more for their dollar: A comparison of the NHS with California's Kaiser Permanente
Richard G.A. Feachem,Director, Institute for Global Health, University of California and Berkeley,CA
Neelam K. Sekhri,Chief Executive Officer,Healthcare Redesign Group,Almeda,CA
Karen L.White, Programme Development Officer, Institute for Global Health,University of California and Berkeley,CA
Objective: To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California.
Methods: The adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators.
Results: The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics,and the cost environment,were similar to within 10%.Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS.
Conclusions: The widely held beliefs that the NHS is
efficient and that poor performance in certain areas is largely
explained by underinvestment are not supported by this
analysis.Kaiser achieved better performance at roughly the same
cost as the NHS because of integration throughout the system,
efficient management of hospital use, the benefits of competition,
and greater investment in information technology.
BMJ 2002; 324: 135-143 (19 January)
From the Annals of Internal MedicinePharmacist Scope of Practice
American College of Physicians-American Society of Internal Medicine
This paper explores the increased scope of practice of U.S.
pharmacists. It presents background information on the pharmacy
profession and outlines how the medical profession can work with
pharmacists to enhance patient safety and quality of care.The paper
calls for further research on the effects of pharmacy automation
and the move to the Doctor of Pharmacy degree on pharmacy
practice.Other positions include support for patient education and
hospital rounds, opposition to independent pharmacist prescriptive
privileges and initiation of drug therapy, increased use of the
pharmacist as immunizer (as allowed by state law), and continued
support for the American College of Physicians-American Society of
Internal Medicine 1990 therapeutic substitution position.
Ann Intern Med. 2002;136:79-85.
Web Exclusives from Health Affairs:
Health Affairs periodically publishes peer-reviewed articles exclusively on its Web site.These articles are selected based on their timeliness and relevance to the contemporary policy debate.They are available in either HTML or PDF format; access is free to all site visitors. See www.healthaffairs.org
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Robert Blendon et al.,November 13,2001
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Reductions in Medicare spending are likely to occur only if beneficiaries'premiums go up.
Kenneth E.Thorpe and Adam Atherly,October 10,2001
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