Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

An opportunity for hospitalists to improve patient care

Robert Centor, MD
Physician
August 18, 2011
Share
Tweet
Share

Some hospitalists are in denial.  Some hospitalists have become methodologic critics.  But all hospitalists should take the findings of the recent Annals of Internal Medicine article seriously.  We should not argue about the article, but rather ask whether these findings point out a weak point in our care of patients.

This article provides an opportunity, not a scolding:

In an accompanying editorial, two other researchers from the VA Medical Center in Ann Arbor, Mich., agreed that the hospitalist model may not be working perfectly, but said it would be premature to call it a failure.

“Hospitalists have filled the gap left by residency work-hour requirements, and they frequently contribute to inpatient quality improvement efforts,” wrote Lena M. Chen, MD, and Sanjay Saint, MD, MPH.

“We need more studies that follow our patients wherever they go and help us practice the sort of coordinated care that is most likely to lead to high-quality outcomes,” they recommended.

This is a correct response.  The long standing program (started after these data occurred) for improving transitions of care between hospitalists and primary care physicians is a correct response.

If the safety movement teaches us anything, it tells us that we must accept inconvenient news and then first do a root cause analysis.  After the root cause analysis, we must perform trials on improving our performance.

The time frame of this study is potentially confusing:

Kuo and Goodwin obtained Medicare payment data on a random, nationally representative 5% sample of beneficiaries receiving care from 2001 to 2006. They limited the main analysis to patients receiving care at hospitals with at least 20 admissions involving hospitalist care and at least 20 in which nonhospitalist primary care physicians (PCPs) were in charge of care.

Any careful observer quickly understands how this might happen.  Any careful observer knows that we have 2 lesions – transfer of information to the hospitalist and transfer of information from the hospitalist.

Likely some hospitalists and some hospitalist programs handle these transitions well.  However, too many patients still “fall through the cracks.”  We spend too much repeating tests on the inpatient side.  We have too many patients present to their PCP without that physician understanding the recent hospitalization.  We lose some of the benefit of excellent hospital care.

The Annals article should be viewed as a wake up call.  I urge my hospitalist colleagues to avoid the ostrich mode, and embrace the study, developing creative methods for fixing the problems.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

ADVERTISEMENT

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Without wives, men’s health suffers

August 18, 2011 Kevin 9
…
Next

Why cutting Medicaid will cost more in the long run

August 19, 2011 Kevin 0
…

Tagged as: Hospital-Based Medicine, Hospitalist

Post navigation

< Previous Post
Without wives, men’s health suffers
Next Post >
Why cutting Medicaid will cost more in the long run

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Robert Centor, MD

  • When the problem representation and the illness script do not match

    Robert Centor, MD
  • Think of diagnostic excellence as playing smooth jazz

    Robert Centor, MD
  • When constipation pain was worse than cancer pain

    Robert Centor, MD

More in Physician

  • How a rainy walk helped an oncologist rediscover joy and bravery

    Dr. Damane Zehra
  • How inspiration and family stories shape our most meaningful moments

    Arthur Lazarus, MD, MBA
  • A day in the life of a WHO public health professional in Meghalaya, India

    Dr. Poulami Mazumder
  • Why women doctors are still mistaken for nurses

    Emma Fenske, DO
  • Adriana Smith’s story: a medical tragedy under heartbeat laws

    Nicole M. King, MD
  • Why U.S. health care pricing is so confusing—and how to fix it

    Ashish Mandavia, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

An opportunity for hospitalists to improve patient care
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...