Hospitalist staffing and patient satisfaction in the national Medicare population.

Abstract

BACKGROUND: Payers are increasingly holding hospitals accountable for patients' experiences with their care. This may conflict with another trend among US hospitals-greater hospitalist care-as hospitalists may have less familiarity with the history and preferences of their patients compared with primary-care physicians. OBJECTIVE: Our objective was to better understand the relationship between hospitalist care and patients' experiences with their care. DESIGN: This was a retrospective cohort study. SETTING: The setting was 2843 US acute-care hospitals (bottom tertile or "non-hospitalist" hospitals: median of 0% of general-medicine patients cared for by hospitalists; middle tertile or "mixed" hospitals: median of 39.5%; top tertile or "hospitalist" hospitals: median of 76.5%). PATIENTS: The patients were 132,814 hospitalized Medicare beneficiaries cared for by a general medicine physician in 2009. MEASUREMENTS: The measurements were hospitalist use, based on Medicare claims data, and patient satisfaction, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. RESULTS: "Hospitalist" hospitals had better performance on global measures of patient satisfaction than "mixed" or "non-hospitalist" hospitals (overall satisfaction: 65.6% vs 63.9% vs 63.9%, respectively, P value for difference < 0.001). Hospitalist hospitals performed better in 6 specific domains of care, with the largest difference in satisfaction with discharge compared with mixed or non-hospitalist hospitals (80.3% vs 79.1% vs 78.1%, P < 0.001). Hospitalist care was not associated with patient satisfaction in 2 domains of care: cleanliness of room and communication with physician. CONCLUSION: For most measures of patient satisfaction, greater hospitalist care was associated with modestly better patient-centered care.