Quality of Care for Decompensated Heart Failure: Comparable Performance between Academic Hospitalists and Non-hospitalists

  • Eduard E. Vasilevskis
  • David Meltzer
  • Jeffrey Schnipper
  • Peter Kaboli
  • Tosha Wetterneck
  • David Gonzales
  • Vineet Arora
  • James Zhang
  • Andrew D. Auerbach
Original Article

DOI: 10.1007/s11606-008-0680-3

Cite this article as:
Vasilevskis, E.E., Meltzer, D., Schnipper, J. et al. J GEN INTERN MED (2008) 23: 1399. doi:10.1007/s11606-008-0680-3

Abstract

Background

Hospitalists improve efficiency, but little information exists regarding whether they impact quality of care.

Objective

To determine hospitalists’ effect on the quality of acute congestive heart failure care.

Design and Participants

Using 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.

Measurements

Quality 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.

Results

Compared 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.

Conclusion

Academic 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.

KEY WORDS

health services researchcongestive heart failurequality of carehospital medicinehospitalists

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Eduard E. Vasilevskis
    • 1
    • 2
  • David Meltzer
    • 3
  • Jeffrey Schnipper
    • 4
  • Peter Kaboli
    • 5
    • 6
  • Tosha Wetterneck
    • 7
  • David Gonzales
    • 8
  • Vineet Arora
    • 3
  • James Zhang
    • 3
  • Andrew D. Auerbach
    • 1
  1. 1.Division of Hospital MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Division of General Internal MedicineUniversity of California San FranciscoSan FranciscoUSA
  3. 3.University of ChicagoChicagoUSA
  4. 4.Brigham and Women’s HospitalBostonUSA
  5. 5.The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical CenterIowa CityUSA
  6. 6.Carver College of MedicineUniversity of IowaIowa CityUSA
  7. 7.School of Medicine and Public Health and the Center for Quality, Improvement and Productivity, University of WisconsinMadisonUSA
  8. 8.Department of MedicineUniversity of New MexicoAlbuquerqueUSA