• Eduard E Vasilevskis, David Meltzer, Jeffrey Schnipper, Peter Kaboli, Tosha Wetterneck, David Gonzales, Vineet Arora, James Zhang, and Andrew D Auerbach.
• Division of Hospital Medicine, University of California San Francisco, San Francisco, CA 94143, USA. Eduard.Vasilevskis@ucsf.edu
• J Gen Intern Med. 2008 Sep 1; 23 (9): 139914061399-406.

BackgroundHospitalists improve efficiency, but little information exists regarding whether they impact quality of care.ObjectiveTo determine hospitalists' effect on the quality of acute congestive heart failure care.Design And ParticipantsUsing data from the Multicenter Hospitalist Study, we retrospectively evaluated quality of care in patients admitted with congestive heart failure who were assigned to hospitalists (n = 120) or non-hospitalists (n = 252) among six academic hospitals.MeasurementsQuality measures included the percentage of patients who had ejection fraction (EF) measurement, received appropriate medications [i.e., angiotensin-converting enzyme inhibitor (ACE-I) or beta-blockers] at discharge, measures of care coordination (e.g., follow-up within 30 days), testing for cardiac ischemia (e.g., cardiac catheterization), as well as hospital length of stay, cost, and combined 30-day readmissions and mortality.ResultsCompared to non-hospitalist physicians, hospitalists' patients had similar rates of EF measurement (85.3% vs. 87.5%; P = 0.57), ACE-I (91.5% vs. 88.0%; P = 0.52), or beta-blocker (46.9% vs. 42.1%; P = 0.57) prescriptions. Multivariable adjustment did not change these findings. Hospitalists' patients had higher odds of 30-day follow-up (adjusted OR = 1.83, 95% CI, 1.44 - 2.93). There were no significant differences between the groups' frequency of cardiac testing, length of stay, costs, or risk for readmission or death by 30-days.ConclusionAcademic hospitalists and non-hospitalists provide similar quality of care for heart failure patients, although hospitalists are paying more attention to longitudinal care. Future efforts to improve quality of care in decompensated heart failure may require attention towards system-level factors.

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