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Debunking the myths about the hospitalists

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Apresentação de Fabiana Rolla no PASHA2010

Publicada em: Saúde e medicina
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Debunking the myths about the hospitalists

  1. 1. Debunking the myths about the hospitalists Fabiana Rolla Spacassassi, MD Universidade Federal de São Paulo Escola Paulista de Medicina 2010
  2. 2. Driving Forces of the Hospitalist Model • Increased volume of outpatient careIncreased volume of outpatient care • Decreased frequency and higher acuity ofDecreased frequency and higher acuity of admissionsadmissions • Demand for MD availability in both settingsDemand for MD availability in both settings • Geography & the inefficiency of a commuteGeography & the inefficiency of a commute • PCP demandPCP demand • Data & success of programs to dateData & success of programs to date • Cost pressures in the marketplaceCost pressures in the marketplace - Length of stay- Length of stay - Utilization of resources- Utilization of resources - Patient satisfaction- Patient satisfaction
  3. 3. The Hospitalist Movement • NAIP: fastest growing medical societyNAIP: fastest growing medical society
  4. 4. Number of U.S. Physicians in Various Specialties 0 5000 10000 15000 20000 Hospitalists, 2001 EPS ID Geriatrics Cardiology ER Hospitalists, 2005* *Lurie JD et al. Am J Med, 1999;106:441
  5. 5. Potential Disadvantages of the Hospitalist Model • Loss of continuity • Information “voltage drop” • Potential patient dissatisfaction
  6. 6. Initial Concerns & Media’s Myths on Hospitalists • There is no movement of anyThere is no movement of any significance taking place in medicinesignificance taking place in medicine • They disrupt careThey disrupt care • They exists only to save moneyThey exists only to save money • They add cost to the systemThey add cost to the system • They are managed care Doc’sThey are managed care Doc’s • Patients don’t like them !Patients don’t like them !
  7. 7. The hospitalist moviment- concerns and myths • patient • Primary care physician (PCP) • Hospital
  8. 8. We’re interested in your feelings about a new model of care... ““...in which a stranger will take...in which a stranger will take care of your child when he/she iscare of your child when he/she is in the hospital, really..really...in the hospital, really..really... sick”sick” What would You say?
  9. 9. We’re interested in your feelings about a new model of care... …in which a colleague of your pediatrician, -an expert in hospital care, who is available to you throughout the day-- will care for your child during the hospital stay. He will keep close contact with him/her and return your child to his/her care after leaving the hospital ” What would You say now?
  10. 10. Benefits for Patients • Taken care by an inpatient specialist • Immediate availability • Changes in plan of care throughout the day • No delays in discharge process • Less PICU admits • Improved quality of care • Reduced LOS
  11. 11. The Concerns of the PCP’s • The door to the hospital will be closedThe door to the hospital will be closed – They will be forced to use the serviceThey will be forced to use the service – It happened with the PICU and the NICUIt happened with the PICU and the NICU • Loss of inpatient skillsLoss of inpatient skills • Poor communicationsPoor communications • Patient dissatisfactionPatient dissatisfaction • Loss of continuityLoss of continuity (*Notice, money is not on the list)
  12. 12. Advantages of Collaboration for PCP’s • Increased office availability withoutIncreased office availability without interruptioninterruption • See more outpatients in same amount ofSee more outpatients in same amount of timetime • No middle of night hospital calls/visitsNo middle of night hospital calls/visits • Concentrate on outpatient CMEConcentrate on outpatient CME • Improved quality of lifeImproved quality of life
  13. 13. Convincing PCP’s • Only voluntary system • Offer what they want – All patients, ad hoc cases, night time admits, consults, procedures, weekends.. • Easily accessible- “only one phone call” • Immediate availability 24/7/365 • Encourage “social” visits • Same day discharge summary • Patients feedback
  14. 14. Intangible Benefits to Hospital • Increased censusIncreased census – PCP’s may send morePCP’s may send more – Insurance companies may send moreInsurance companies may send more • Improved quality of careImproved quality of care • Increased market shareIncreased market share • Decreased cost of hospitalizationDecreased cost of hospitalization • Decreased malpractice ?Decreased malpractice ?
  15. 15. The Hospitalist Movement 5 Years Later (JAMA; 2002;287:487-494) • Reduced hospital costs (13%) • Reduced LOS (16%) • Quality measures not harmed • No mandatory referrals • Primary Care Physicians support is critical • Inpatient satisfaction preserved • Communication is the key to success
  16. 16. Few Predictions • Hospitalists will become the major providers of hospital care in the U.S. • Studies will continue to show improved efficiency, improved quality, and patient and PCP satisfaction • Effective systems will overcome the potential flaw in the model: communication • The brutal healthcare marketplace will not tolerate a failure to innovate in the name of tradition
  17. 17. Comparison of hospitalist and pediatric subspecialist care on selected APR-DRG’: lenght of stay and hospital charges Maggioni A, Rolla F. Pediatr res 2004;55(suppl):1790 • APR-DRG severity adjusted retrospectiveAPR-DRG severity adjusted retrospective observational studyobservational study • Hospitalist vsHospitalist vs subspecialists in a ward settingsubspecialists in a ward setting • 20 most common diagnoses20 most common diagnoses • 10231 patients (3958 hosp x 6273 spec)10231 patients (3958 hosp x 6273 spec) • LOS 20% shorter for hospitalists (3.8 vs 4.8 d)LOS 20% shorter for hospitalists (3.8 vs 4.8 d) • hospital costs 31% lower ($10 529 vs $15 380)hospital costs 31% lower ($10 529 vs $15 380)
  18. 18. Pediatric Hospitalists: A systematic review of the literature (Pediatrics. 2006;117(5):1736-1744) • 47 publications reviewed,, • 2020 met criteria for inclusion;; • 6/7 compared traditional and hospitalist systems of care demonstrated improvements in costs and/or length of stay;; • average decrease in cost was 10%; • average decrease in length of stay was 10%.;; • efficiency gains do not generally translate into revenues for the hospitalist programs themselves;; • Surveys of families, referring providers, and pediatric residents demonstrate neutral or improved experiences in hospitalist systems
  19. 19. Charles Darwin It is not the Strongest, nor theIt is not the Strongest, nor the Smartest that will survive !Smartest that will survive ! It is the species that canIt is the species that can best adapt to change.best adapt to change.
  20. 20. A, B, C’s for being a successful pediatric hospitalist • Always • Be • Competente • Collegial, and • Communicative So, You want to be a Hospitalist... Jack M. Percelay, MD, MPH, FAAP AAP Section on Hospital Medicine March 2006

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