Hospitalist Staffing and Patient Satisfaction in the National Medicare Population

Abstract

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. Our objective was to better understand the relationship between hospitalist care and patients' experiences with their care. This was a retrospective cohort study. 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%). The patients were 132,814 hospitalized Medicare beneficiaries cared for by a general medicine physician in 2009. 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. "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. For most measures of patient satisfaction, greater hospitalist care was associated with modestly better patient-centered care.