A Multicenter Trial of Academic Hospitalists

Study Overview
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Brief Summary
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Care of hospitalized patients by hospitalists -- often defined as physicians who dedicate at least 25% of their practice to inpatient care -- is a recent, growing, and controversial trend in health care delivery in the United States. But despite the growth of interest in hospitalists, there have been few scientific evaluations of the concept. The comprehensive aim of this research study is to measure and analyze the effects of hospitalists on patient outcomes, costs and medical education on the general medical services of a group of academic centers.

Detailed Description
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In 2001, a study titled, A Multi-Center Trial of Academic Hospitalists began at the University of Chicago Hospital along with five additional academic institutions. The study is currently and successfully collecting data solely at the University of Chicago Medical Center. The comprehensive aim of this proposed research is to measure and analyze the effects of hospitalists on patient outcomes, costs, and medical education on the general medicine services at the University of Chicago Medical Center (UC). The comprehensive aim of this research will be pursued through five specific aims: Specific Aim #1- To assess whether hospitalists affect the cost and quality of inpatient care. This will be accomplished by analyzing the outcomes of 50,000 patients assigned to hospitalists or non-hospitalists using a quasi-randomized design based on day of the week of admission. Outcomes will include in-hospital and post-discharge mortality, readmission, emergency room use, and patient satisfaction. Specific Aim #2- To assess the mechanisms by which hospitalists may effect the cost and quality of care. Understanding these mechanisms is essential if hospitalist programs are to be designed in ways that permit them to achieve their desired benefits. We will develop measures to assess the whether these possible mechanisms by which hospitalists may have their effects are related to costs and outcomes. Specific Aim #3- To assess the effects of hospitalists on housestaff and student education and satisfaction. This will be accomplished by surveys administered to medical students and housestaff. Specific Aim #4 - To attempt to quantify primary care providers' (PCP's) satisfaction with the frequency, promptness, manner, and content of communication with the in-hospital healthcare team, and to assess differences in PCP satisfaction with teams led by hospitalist and non-hospitalist attending physicians. We hypothesize that deficiencies in such communication may impair continuity of care with outpatient physicians during hospitalization and at the time of discharge, and may be improved when the attending physician is a hospitalist. Specific Aim #5- To assess the quality of care for vulnerable elders for specific geriatric syndromes and diseases by modifying our current surveys and chart abstraction tools in our project with questions aimed to address these issues.

Official Title
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A Multicenter Trial of Academic Hospitalists

Conditions
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Healthy

Intervention / Treatment
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* Behavioral: Observation (behavior)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: General Medicine inpatients at the University of Chicago Hospital or Mercy Hospital in Chicago Illinois Exclusion Criteria: Non-General Medicine inpatients

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Observation (behavior)|Inpatients admitted in GenMed at the University of Chicago will be consented to participate in an inpatient interview that consists of questions related to quality of care and satisfaction. The patient will also be interviewed over the phone 30 days after discharge and will be asked questions related to current health and their satisfaction during their stay at University of Chicago.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the effects of hospitalists on patient outcomes, costs, and medical education on the general medicine services | This will be accomplished by analyzing the outcomes of 60,000 patients assigned to hospitalists or non-hospitalists using a quasi-randomized design based on day of the week of admission. Outcomes will include in-hospital and post-discharge mortality, readmission, emergency room use, and patient satisfaction | 30 days after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the effects of hospitalists on housestaff and student education and satisfaction | This will be accomplished by surveys administered to medical students and housestaff. | 1 academic year | 
| quality of care for vulnerable elders | chart abstraction tools in our project with questions aimed to address these issues | 30 days after discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hospitalists