Special Article
Growth in the Care of Older Patients by Hospitalists in the United States
N Engl J Med 2009; 360:1102-1112March 12, 2009DOI: 10.1056/NEJMsa0802381
- Abstract
Background
National and population-based information on the increase in patient care by hospitalists in the United States is lacking.
Methods
Using a 5% sample of Medicare beneficiaries in 1995, 1997, 1999, and the period from 2001 through 2006, we identified 120,226 physicians in general internal medicine who were providing care to older patients in 5800 U.S. hospitals. We defined hospitalists as general internists who derived 90% or more of their Medicare claims for evaluation-and-management services from the care of hospitalized patients. We then calculated the percentage of all inpatient Medicare services provided by hospitalists and identified patient and hospital characteristics associated with the receipt of hospitalist services.
Results
The percentage of physicians in general internal medicine who were identified as hospitalists increased from 5.9% in 1995 to 19.0% in 2006, and the percentage of all claims for inpatient evaluation-and-management services by general internists that were attributed to hospitalists increased from 9.1% to 37.1% during this same period. Accompanying the increase in care by hospitalists was an increase in the percentage of all hospitalized Medicare patients who were treated by general internists (both hospitalists and traditional, non–hospital-based general internists), from 46.4% in 1995 to 61.0% in 2006. In a multilevel, multivariable analysis controlling for patient and hospital characteristics, the odds of receiving care from a hospitalist increased by 29.2% per year from 1997 through 2006. In 2006, there was marked geographic variation in the rates of care provided by hospitalists, with rates of more than 70% in some hospital-referral regions.
Conclusions
These analyses of data from Medicare claims showed a substantial increase in the care of hospitalized patients by hospitalist physicians from 1995 to 2006.
Media in This Article
Figure 1
Distribution of Physicians in General Internal Medicine According to the Percentage of Evaluation-and-Management Medicare Claims Generated from the Care of Hospitalized Patients, 2001 through 2006.Figure 2
Growth of Hospitalist Care in U.S. Hospitals from 1995 through 2006.Article Activity
- Article
Since the mid-1990s, there has been rapid growth in the number of hospitalists and the number of hospitals served by hospitalist groups.1-10 The Society of Hospital Medicine estimated a 20% increase in the number of hospitalists between 2005 and 2006.10 A 2005 survey by the American Hospital Association showed that 40% of community hospitals had hospitalist programs, and a 2006–2007 survey showed that at least 59% of all hospitals in California had hospitalist programs.7,8
Surveys also indicate that approximately 85% of hospitalists are trained in internal medicine.4 Approximately 96% of the clinical encounters of self-identified hospitalists are with hospitalized patients.4
Although survey data have shown a sharp increase in the number of hospitalists, the response rates in these surveys are generally low. To our knowledge, there are no national or population-based data on hospitalist care. Using national Medicare data, we assessed the growth in hospitalist care in 5800 U.S. hospitals from 1995 through 2006 and examined variations in this growth according to patient and hospital characteristics.
Methods
Source of Data
Data on hospitalist care were obtained from the Centers for Medicare and Medicaid Services Provider of Service File and claims and enrollment files from the years 1995, 1997, and 1999 and the period from 2001 through 2006 for a 5% national sample of Medicare beneficiaries.
Measures
Demographic characteristics of patients were determined from enrollment files, and hospital-admission data (e.g., emergency department vs. nonemergency admission, weekend vs. weekday admission, and diagnosis-related group [DRG]) from the Medicare Provider Analysis and Review (MedPAR) files. Data on the physician's specialty were obtained from Part B claims in the Medicare carrier files in a given year. Physicians with multiple specialty codes were assigned the specialty that appeared most often in their claims for that year. We also performed analyses in which physicians with more than one specialty code were excluded, and the results of these analyses were similar. Hospital characteristics (e.g., ZIP Code, county, state, total number of beds, type of hospital, and medical-school affiliation) were obtained from 2004 Provider of Service files. Data on the sizes of metropolitan areas were obtained from 2000 Census data.
Hospital-referral regions are described in the Dartmouth Atlas of Health Care.11 The size of each metropolitan area and the total number of beds were categorized according to quartiles. States were grouped as Census regions; the type of hospital was categorized as not-for-profit, for-profit, or government; and the medical-school affiliation was categorized as none, minor, or major.
Identification of Hospitalists
We defined hospitalists as physicians in general internal medicine who had at least five evaluation-and-management billings in a given year and generated at least 90% of their total evaluation-and-management billings in the year from services to hospital inpatients (Figure 1Figure 1
Distribution of Physicians in General Internal Medicine According to the Percentage of Evaluation-and-Management Medicare Claims Generated from the Care of Hospitalized Patients, 2001 through 2006.). Since our source of data is a 5% sample, these five evaluation-and-management billings represent 100 or more charges to Medicare patients. Using inpatient evaluation-and-management billing codes (Current Procedural Terminology [CPT] codes 99221–99223, 99231–99233, and 99251–99255) and outpatient evaluation-and-management billing codes (CPT codes 99201–99205, 99211–99215, and 99241–99245), we calculated the percentage of each physician's evaluation-and-management claims that were generated from services provided to hospitalized patients.We analyzed the effect of different cutoff points according to the percentage of evaluation-and-management charges generated from care provided to hospitalized patients (≥80% vs. ≥90%) and according to the minimum number of evaluation-and-management charges in a given year in the 5% sample of Medicare data (≥5 vs. ≥10) in the algorithm to identify hospitalists. We tested the algorithm in a validation set of 57 hospitalists and 172 physicians in traditional non–hospital-based general internal medicine (hereafter referred to as nonhospitalists) employed in 2006 at seven hospitals. These hospitals were located in California (University of California, Los Angeles, Medical Center), Michigan (Wayne State University Detroit Medical Center), Virginia (Hospital Corporation of America [HCA]–affiliated hospitals in Richmond, including Henrico Doctors' Hospital, John Randolph Medical Center, HCA Retreat Hospital, Johnston Willis Hospital, and Chippenham Hospital), Wisconsin (Sinai Samaritan Medical Center), and Texas (University of Texas Medical Branch, Clear Lake Regional Medical Center, and University of Texas Health Science Center at San Antonio). The algorithm requiring a minimum of 5 evaluation-and-management charges per physician in a given year and the algorithm requiring 10 or more such charges, with both requiring that 90% or more of the charges represent the care of hospitalized patients, had a sensitivity of 84.2% and 71.9%, a specificity of 96.5% and 97.1%, and a positive predictive value of 88.9% and 89.1%, respectively. The algorithm requiring 5 or more evaluation-and-management charges and the algorithm requiring 10 or more such charges, with both requiring that 80% or more of the charges represent the care of hospital inpatients, had a sensitivity of 87.7% and 73.7%, a specificity of 93.0% and 94.2%, and a positive predictive value of 80.6% and 80.8%, respectively. The sensitivities of the four algorithms were very similar (91.1%, 88.9%, 91.1%, and 88.9%, respectively) when applied to 45 hospitalists in two hospitalist groups serving community hospitals in the Houston and Austin metropolitan areas. We selected the algorithm requiring at least five evaluation-and-management charges with at least 90% of such charges generated from the care of hospital inpatients because the sensitivity (84.2%) and positive predictive value (88.9%) were acceptable.
We also evaluated the specificity of the algorithm by assessing whether hospitalists in general internal medicine identified by the algorithm submitted claims for procedures that are not usually performed by general internists; these procedures included colonoscopy, upper endoscopy, liver biopsy, hemodialysis, peritoneal dialysis, kidney biopsy, bronchoscopy, and cardiac catheterization. In 1995, the proportion of physicians identified as hospitalists who billed for one or more of these procedures was 14.9%; this percentage decreased to 2.3% in 2006. In some analyses, we also calculated the percentage of physicians in other specialties for whom more than 90% of evaluation-and-management billing codes were generated from services provided to hospitalized patients.
Identification of Patients Who Received Care from a Hospitalist
All 5,300,657 hospital admissions in 1995, 1997, 1999, and the period from 2001 through 2006 in MedPAR files were selected. We censored data on 6077 admissions that could not be linked to Provider of Service files. For most analyses, we also censored data on 2,969,722 admissions that did not involve a charge for evaluation-and-management services by a physician in general internal medicine. The admissions were categorized according to whether the evaluation-and-management services by physicians in general internal medicine had been provided by a hospitalist or nonhospitalist. In 174,579 admissions, patients received care from both hospitalists and nonhospitalists (about 3 to 6% of admissions in the period from 1995 through 2001 and 7 to 11% in the period from 2002 through 2006). Data on these admissions were censored, leaving 2,150,279 admissions involving 990,785 patients in 5800 hospitals.
Statistical Analysis
The proportions of admissions involving care by hospitalists were calculated, plotted according to year, and then stratified according to selected patient and hospital characteristics. In this multilevel analysis, the effect of patient and hospital characteristics on whether or not a patient was cared for by a hospitalist was evaluated with the use of a hierarchical generalized linear model with a logistic link to adjust for clustering of admissions (level 1) within hospitals (level 2). Because there were interactions between the year of admission and the characteristics of the patients and hospitals, stratified, hierarchical generalized linear models for the years 1997, 2001, and 2006 were constructed. All tests of statistical significance were two-sided. Analyses were performed with the use of SAS statistical software, version 9.1 (SAS Institute).
Results
Identification of Hospitalists
Figure 1 shows the distribution of general internists according to the percentage of their evaluation-and-management billing codes generated from the care of hospitalized patients. Data are presented for each year from 2001 through 2006. During this period, the percentage of physicians generating less than 10% or 90% or more of their evaluation-and-management codes from services provided to hospital inpatients increased. Conversely, the percentage of physicians with more balanced distributions between inpatient and outpatient services decreased.
Growth in Hospitalist Care
We next defined hospitalists as physicians who generated more than 90% of their evaluation-and-management claims from the care of hospitalized patients. As shown in Figure 2AFigure 2
Growth of Hospitalist Care in U.S. Hospitals from 1995 through 2006., the percentage of hospitalists among general internists increased from 5.9% in 1995 to 19.0% in 2006, with rapid growth starting in 1997. Also shown are the percentages of cardiologists, pulmonologists, gastroenterologists, and family physicians and general practitioners who met the definition of hospitalist. The percentages of cardiologists, gastroenterologists, and family physicians and general practitioners who were hospitalists remained low over time; the percentage of pulmonologists who were hospitalists was higher but increased only slightly over time.The rapid growth in care by hospitalists who were general internists was accompanied by an increase in the percentage of all hospitalized patients who were seen by any general internist (either hospitalist or nonhospitalist). In 1995, a total of 46.4% of all Medicare admissions were associated with an evaluation-and-management claim by a general internist. This percentage increased to 61.0% by 2006. The increase was similar for patients with medical DRG codes (from 47.3% to 62.7%) and those with surgical DRG codes (from 43.3% to 55.3%). All results reported below are limited to analyses of data for patients seen in the hospital by a general internist.
The percentage of all evaluation-and-management claims by physicians in general internal medicine for the care of hospitalized Medicare patients that was attributable to hospitalists increased from 9.1% in 1995 to 37.1% in 2006. Figure 2B through 2H show how the percentage of patients cared for by hospitalists varied over time and according to patient and hospital characteristics. The increase in care by hospitalists was highest in the mountain states and lowest in the mid-Atlantic states (Figure 2B). Nonteaching hospitals lagged approximately 1 year behind teaching hospitals in terms of the increase in care by hospitalists (Figure 2C). With respect to this increase, there was a clear relationship to hospital size, with the largest hospitals about 2 years ahead of the smallest hospitals (Figure 2D). Black patients were more likely than white patients to receive hospitalist care in the late 1990s, but this difference disappeared by 2006 (Figure 2E). The increase in hospitalist care was greater for admissions from the emergency room than for non–emergency room admissions (Figure 2F). Among surgical patients, the largest increase in hospitalist care was for orthopedic surgery (Figure 2G). Differences in the increase in care by hospitalists according to medical diagnoses were relatively small (Figure 2H); patients with neurologic diagnoses were most likely to be cared for by hospitalists. The results were similar when the data were stratified according to the patient's age and sex and according to whether the hospital was a not-for-profit or a for-profit hospital.
The percentage of hospitals with at least three hospitalists increased from 11.6% in 1995 to 47.1% in 2006, with an increase from 41.9% to 83.7% among major teaching hospitals and an increase from 5.5% to 38.4% among nonteaching hospitals. Among hospitals with any hospitalists, the median number of hospitalists per hospital was two in 1995, two in 2001, and four in 2006. In major teaching and nonteaching hospitals, the median numbers of hospitalists were 11 and 3, respectively, in 2006.
Variation in Hospitalist Use
Figure 3Figure 3
Hospitalist Care of Medicare Patients in 306 Hospital-Referral Regions in 1997, 2001, and 2006. shows the proportions of admitted Medicare patients who were cared for by hospitalists in 306 hospital-referral regions in 1997, 2001, and 2006. The geographic variation in rates of care by hospitalists increased during this period. By 2006, the hospital-referral regions with the highest percentages of patients who received care from hospitalists included St. Cloud, Minnesota (85.6%), Mesa, Arizona (84.0%), Appleton, Wisconsin (81.6%), Austin, Texas (80.5%), and Bangor, Maine (80.3%). In 56 hospital-referral regions, more than 50% of inpatients cared for by general internists received hospitalist care in 2006.In a multilevel, multivariable analysis that included patient and hospital characteristics, the odds that a hospitalized Medicare patient was cared for by a hospitalist increased 29.2% per year during the period from 1997 through 2006. In this analysis, there were significant interactions between the year and most other variables. In Table 1Table 1
Multilevel, Multivariable Analysis of the Odds of Receiving Care by a Hospitalist among Medicare Patients Hospitalized in 1997, 2001, and 2006., separate analyses of data from 1997, 2001, and 2006 show the change over time in the relationship of patient and hospital characteristics to the odds of receiving hospitalist care. In 1997, black patients were more likely than white patients to receive hospitalist care, but this difference had diminished by 2006. Similarly, the variations according to the size of the metropolitan area, type of hospital, and hospital teaching status observed in 1997 had decreased by 2006. Conversely, variations according to geographic region and according to the type of hospital admission (emergency room vs. nonemergency type of admission) increased over time. There was clear variation according to hospital size during all three time periods.Characteristics of Hospitalists
The number of hospitalists who were general internists increased from 2770 in 1995 to 13,466 in 2006. In 2006, a total of 4839 hospitalists were practicing at major teaching hospitals, 3905 at minor teaching hospitals, and 7498 at nonteaching hospitals (some hospitalists practiced at more than one type of hospital).
To assess the career trajectory of hospitalists, we examined the billing patterns in the years before and after 2002 among the 6898 general internists identified as hospitalists in 2002 (Figure 4Figure 4
Pattern of Medicare Claims in the Years before and after 2002 among Physicians in General Internal Medicine Who Were Identified as Hospitalists in 2002.). The data suggest that most hospitalists in 2002 had been in training within the previous 3 to 5 years, because they had not generated Medicare charges in previous years. Most of the hospitalists in 2002 were still practicing hospital medicine during the following 4 years, with smaller proportions of hospitalists returning to further training or switching to outpatient practice.We assessed how the career stability of hospitalists changed over time by calculating the percentage of hospitalists who still generated more than 90% of evaluation-and-management claims from the care of hospitalized patients 2 years later. Of the hospitalists identified in 1995, a total of 33.4% were still generating more than 90% of evaluation-and-management claims from the care of hospitalized patients in 1997. Of the hospitalists identified in 2004, a total of 65.7% were still generating 90% or more of these claims from the care of hospitalized patients in 2006.
Discussion
The major finding of this study is the very rapid growth in care by hospitalists in the late 20th and early 21st century. The odds that a hospitalized Medicare patient would receive care from a hospitalist increased by 29.2% per year from 1997 to 2006. The map of hospitalist penetration according to hospital-referral region (Figure 3) shows that by 2006, almost all areas of the United States were served by hospitalists. Also, although the growth of care by hospitalists has been greater in large hospitals, teaching hospitals, and in certain geographic areas, substantial growth occurred in every area and type of hospital.
The growth in care by hospitalists who are general internists resulted in an increase in the percentage of all Medicare inpatients who were cared for by a general internist, whether hospitalist or nonhospitalist, from 46.4% in 1995 to 61.0% in 2006. The increase in care by hospitalists (Figure 2A) started before prospective trials and observational studies showed that hospitalists were associated with decreased hospital costs, with no deleterious effect on outcomes.12-17 Saint and colleagues18 made a similar point in their analysis of 1994 Medicare data from Washington State.
Our data also suggest that the career stability of hospitalists has increased over time. Only 33.4% of physicians identified as being hospitalists in 1995 still met the definition 2 years later, whereas 65.7% of hospitalists identified in 2004 still derived 90% or more of their claims from the care of hospitalized patients 2 years later.
This research has limitations. Analyses of Medicare claims will not identify pediatric hospitalists19,20 and hospitalists who only treat patients in health maintenance organizations (HMOs). Our definition also excludes medical subspecialists and family physicians who are hospitalists. A 2006–2007 survey by the Society of Hospital Medicine showed that 82.3% of hospitalists were general internists, 4.0% were internal-medicine subspecialists, 3.7% were family practitioners, and 10% were pediatricians or pediatricians who were also internists.4
Because we were assessing only hospitalists in general internal medicine, our estimates of the percentage of patients cared for by hospitalists were limited to those patients who received care from any physician in general internal medicine while hospitalized. Including all hospitalized patients in the denominator would result in lower estimates of hospitalist care, but it would not substantially alter the association of patient and hospital characteristics with hospitalist use. The only noteworthy change was a much lower estimate for cardiology surgical DRGs.
We considered a physician to be a “general internist” based on the specialty code shown on the majority of his or her Part B claims in a given year. This method has been used in previous studies,21-23 and it may differ somewhat from other sources of specialty information, such as the Physician Masterfile of the American Medical Association and the Unique Physician Identification Number Directory.24
We used a functional definition of hospitalist, whereas previous studies of hospitalists have been based on self-report (i.e., a hospitalist is a physician who calls himself or herself a hospitalist). We chose a cutoff point of 90% for evaluation-and-management claims generated from the care of hospitalized patients because that was the category that grew rapidly from 2001 through 2006. Our estimate of the number of hospitalists nationally was dependent on cutoff points chosen for the algorithms. For example, the estimated number of hospitalists in 2006 was 13,466 with the use of the cutoff point of 90% for evaluation-and-management charges generated from the care of hospitalized patients. At a cutoff point of 50%, the estimate would be 23,112; at 70%, it would be 17,568; and at 80%, it would be 15,560. Many early descriptions of hospitalists were of physicians who devoted more than 50% of their clinical time to inpatient care but continued to provide outpatient care.12,13,18 Our definition would have missed many of these persons. It is not clear to what extent this model is still followed.25 A 2007–2008 survey of hospitalist physicians showed that, on average, only 1.1% of their total encounters were with outpatients and only 0.9% were with patients in the emergency room, suggesting that the great majority of hospitalists today are devoting their time almost exclusively to the care of hospitalized patients.4
The estimate of hospitalists was also dependent on the cutoff point chosen for the minimum number of Medicare evaluation-and-management charges in the 5% Medicare sample in order for a physician to be included in the analyses. If we had changed the cutoff point from 5 evaluation-and-management charges to 10, then the estimated number of hospitalists in 2006 would have decreased from 13,466 to 11,897. However, the use of different cutoff points for the number of evaluation-and-management charges or the percentages of these charges generated from services provided to hospitalized patients did not greatly affect the dramatic growth of hospitalists over the period from 1995 through 2006.
The specificity of our definition seems to have improved over time. As noted in the Methods section, 14.9% of physicians who were identified as hospitalists in 1995 billed for procedures normally performed by subspecialists, and this percentage decreased to 2.3% in 2006.
Another limitation of our study is that some of our inferences are based on indirect data. For example, we inferred from the data in Figure 4 that an absence of Medicare billing indicated that the physician was in training, but retired physicians or full-time employees of HMOs or government hospitals also might not generate Medicare charges.
The rapid growth of care by hospitalists exemplifies the dynamic nature of medical care in the United States in recent years. The decreased variation in rates of hospitalist care over time according to most patient and hospital characteristics is consistent with previous studies of the diffusion of new medical practices and techniques.26,27 Medicare data allow us to track many of those changes at a national level.
Supported by grants from the Claude D. Pepper Older Americans Independence Center (5P30AG024832) and the Center for Population Health and Health Disparities (5P50CA105631) at the University of Texas Medical Branch.
Dr. Sharma reports receiving lecture fees from Pfizer. No other potential conflict of interest relevant to this article was reported.
We thank Hyunsu Ju, Ph.D., for assistance with preparation of an earlier version of the map and Kelley Prevou and Sarah Toombs Smith, Ph.D., for assistance with preparation of an earlier version of the manuscript.
Source Information
From the Department of Internal Medicine and the Sealy Center on Aging, University of Texas Medical Branch, Galveston.
Address reprint requests to Dr. Kuo at the Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0460, or at yokuo@utmb.edu.
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Aaron J. Calderon, Mark H. Wener. (2012) Erythrocyte Sedimentation Rate and C-Reactive Protein. Hospital Medicine Clinics
19
Stephen R. Holt, Jorge Ramos, Michael A. Harma, Felix Cabrera, Coeurlida Louis-Ashby, An Dinh, Jeanette M. Tetrault, David A. Fiellin. (2012) Prevalence of Unhealthy Substance Use on Teaching and Hospitalist Medical Services: Implications for Education. The American Journal on Addictionsno-no
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David J. Rosenberg. (2012) Infections, bacterial resistance, and antimicrobial stewardship: The emerging role of hospitalists. Journal of Hospital Medicine 7:S1, S34-S43
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Stephen M. Pastores, Michael F. OʼConnor, Ruth M. Kleinpell, Lena Napolitano, Nicholas Ward, Heatherlee Bailey, Fred P. Mollenkopf, Craig M. Coopersmith. (2011) The Accreditation Council for Graduate Medical Education resident duty hour new standards: History, changes, and impact on staffing of intensive care units*. Critical Care Medicine 39:11, 2540-2549
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Caroline Y. Lin, Amber E. Barnato, Howard B. Degenholtz. (2011) Physician Follow-Up Visits After Acute Care Hospitalization for Elderly Medicare Beneficiaries Discharged to Noninstitutional Settings. Journal of the American Geriatrics Society 59:10, 1947-1954
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Chin-Chung Shu, Jou-Wei Lin, Yu-Feng Lin, Nin-Chieh Hsu, Wen-Je Ko. (2011) Evaluating the performance of a hospitalist system in Taiwan: A pioneer study for nationwide health insurance in Asia. Journal of Hospital Medicine 6:7, 378-382
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Michael Storey, Sara White, Robert J. Weber. (2011) Director’s Forum - Practice Models: What Are Other Professions Doing?. Hospital Pharmacy 46:9, 709-718
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Ashlee McMillan, Jessica Trompeter, Dawn Havrda, Jeremy Fox. (2011) Continuity of Care Between Family Practice Physicians and Hospitalist Services. Journal for Healthcare Qualityn/a-n/a
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Bret T. Howrey, Yong-Fang Kuo, James S. Goodwin. (2011) Association of Care by Hospitalists on Discharge Destination and 30-day Outcomes After Acute Ischemic Stroke. Medical Care 49:8, 701-707
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Angelena Maria Labella, Susan Eva Merel, Elizabeth Anne Phelan. (2011) Ten ways to improve the care of elderly patients in the hospital. Journal of Hospital Medicine 6:6, 351-357
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Robert El-Kareh, Christopher Roy, Gregor Brodsky, Molly Perencevich, Eric G. Poon. (2011) Incidence and predictors of microbiology results returning postdischarge and requiring follow-up. Journal of Hospital Medicine 6:5, 291-296
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Robert M. Crane, Brian Raymond. (2011) Roundtable on Public Policy Affecting Patient Safety. Journal of Patient Safety 7:1, 5-10
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Nazima Allaudeen, Arpana Vidyarthi, Judith Maselli, Andrew Auerbach. (2011) Redefining readmission risk factors for general medicine patients. Journal of Hospital Medicine 6:2, 54-60
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Chin-Chung Shu, Nin-Chieh Hsu, Yu-Feng Lin, Jann-Yuan Wang, Jou-Wei Lin, Wen-Je Ko. (2011) Integrated postdischarge transitional care in a hospitalist system to improve discharge outcome: an experimental study. BMC Medicine 9:1, 96
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James C. Pile. (2011) Antimicrobial stewardship: Optimizing antibiotic use in an era of increasing resistance and rising costs. Journal of Hospital Medicine 6:S1, S1-S3
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Ami Schattner, Christopher Davidson, Verena Briner. (2010) The European School of Internal Medicine (ESIM) and Internal Medicine in 2030. European Journal of Internal Medicine 21:6, 509-510
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Darlene E. Ferranti, Gregory Makoul, Victoria E. Forth, Jennifer Rauworth, Jungwha Lee, Mark V. Williams. (2010) Assessing patient perceptions of hospitalist communication skills using the Communication Assessment Tool (CAT). Journal of Hospital Medicine 5:9, 522-527
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Lindsay Mazotti, Adam Moylan, Elizabeth Murphy, G. Michael Harper, C. Bree Johnston, Karen E. Hauer. (2010) Advancing geriatrics education: An efficient faculty development program for academic hospitalists increases geriatric teaching. Journal of Hospital Medicine 5:9, 541-546
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Yong-Fang Kuo, James S. Goodwin. (2010) Effect of Hospitalists on Length of Stay in the Medicare Population: Variation According to Hospital and Patient Characteristics. Journal of the American Geriatrics Society 58:9, 1649-1657
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Susan E. Merel, Wayne McCormick. (2010) Geriatricians and Hospitalists: Opportunities for Partnership. Journal of the American Geriatrics Society 58:9, 1803-1805
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Gregory A. Harlan, Flory L. Nkoy, Rajendu Srivastava, Gena Lattin, Doug Wolfe, Michael B. Mundorff, DayValena Colling, Angelika Valdez, Shay Lange, Sterling D. Atkinson, Lawrence J. Cook, Christopher G. Maloney. (2010) Improving Transitions of Care at Hospital Discharge-Implications for Pediatric Hospitalists and Primary Care Providers. Journal for Healthcare Quality 32:5, 51-60
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Rajiv Thakkar, Scott M. Wright, Patrick Alguire, Robert S. Wigton, Romsai T. Boonyasai. (2010) Procedures Performed by Hospitalist and Non-hospitalist General Internists. Journal of General Internal Medicine 25:5, 448-452
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Luci Leykum, Eric Mortensen. (2010) Exploring the Potential Causes of the Emergence of Hospitalists: Chicken vs. Egg. Journal of General Internal Medicine 25:5, 378-379
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Eduard E. Vasilevskis, R. Justin Knebel, R. Adams Dudley, Robert M. Wachter, Andrew D. Auerbach. (2010) Cross-sectional analysis of hospitalist prevalence and quality of care in California. Journal of Hospital Medicine 5:4, 200-207
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Thanjavur S. Ravikumar, Cordelia Sharma, Corrado Marini, Glenn D. Steele, Garry Ritter, Rafael Barrera, Mimi Kim, Steven M. Safyer, Kathy Vandervoort, Marcella De Geronimo, Lindsay Baker, Peter Levi, Steven Pierdon, Meg Horgan, Kenric Maynor, Gerald Maloney, Mark Wojtowicz, Karen Nelson. (2010) A Validated Value-Based Model to Improve Hospital-Wide Perioperative Outcomes. Transactions of the ... Meeting of the American Surgical Association 128, 81-95
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Michael Heisler. (2010) Hospitalists and intensivists: Partners in caring for the critically illâThe time has come. Journal of Hospital Medicine 5:1, 1-3
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Richard C. Wender, Marc Altshuler. (2009) Can the Medical Home Reduce Cancer Morbidity and Mortality?. Primary Care: Clinics in Office Practice 36:4, 845-858
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Youcef Sennour, Steven R. Counsell, Jerrlyn Jones, Michael Weiner. (2009) Development and Implementation of a Proactive Geriatrics Consultation Model in Collaboration with Hospitalists. Journal of the American Geriatrics Society 57:11, 2139-2145
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Eduard E. Vasilevskis, R. Justin Knebel, Robert M. Wachter, Andrew D. Auerbach. (2009) California hospital leaders' views of hospitalists: Meeting needs of the present and future. Journal of Hospital Medicine 4:9, 528-534
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Daniel Hunt. (2009) Hospitalists' path to becoming the best educators in the hospital. Journal of Hospital Medicine 4:8, 463-465
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(2009) Growth in Care Provided by Hospitalists. New England Journal of Medicine 360:26, 2789-2791
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Mark V. Williams, Eric Coleman. (2009) BOOSTing the hospital discharge. Journal of Hospital Medicine 4:4, 209-210
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Hamel , Mary Beth , Drazen , Jeffrey M. , Epstein , Arnold M. , . (2009) The Growth of Hospitalists and the Changing Face of Primary Care. New England Journal of Medicine 360:11, 1141-1143
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