• James S Goodwin, Yu-Li Lin, Siddhartha Singh, and Yong-Fang Kuo.
• Department of Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA. jsgoodwi@utmb.edu
• J Gen Intern Med. 2013 Mar 1; 28 (3): 370376370-6.

BackgroundThere have been no prior population-based studies of variation in performance of hospitalists.ObjectiveTo measure the variation in performance of hospitalists.DesignRetrospective research design of 100 % Texas Medicare data using multilevel, multivariable models.Subjects131,710 hospitalized patients cared for by 1,099 hospitalists in 268 hospitals from 2006-2009.Main MeasuresWe calculated, for each hospitalist, adjusted for patient and disease factors (case mix), their patients' average length of stay, rate of discharge home or to skilled nursing facility (SNF) and rate of 30-day mortality, readmissions and emergency room (ER) visits.Key ResultsIn two-level models (admission and hospitalist), there was significant variation in average length of stay and discharge location among hospitalists, but very little variation in 30-day mortality, readmission or emergency room visit rates. There was stability over time (2008-2009 vs. 2006-2007) in hospitalist performance. In three-level models including admissions, hospitalists and hospitals, the variation among hospitalists was substantially reduced. For example, hospitals, hospitalists and case mix contributed 1.02 %, 0.75 % and 42.15 % of the total variance in 30-day mortality rates, respectively.ConclusionsThere is significant variation among hospitalists in length of stay and discharge destination of their patients, but much of the variation is attributable to the hospitals where they practice. The very low variation among hospitalists in 30-day readmission rates suggests that hospitalists are not important contributors to variations in those rates among hospitals.

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