Inpatient Management by Hospitalists versus Community Pediatricians

Abstract

Hospital Care| February 01 2007 Inpatient Management by Hospitalists versus Community Pediatricians AAP Grand Rounds (2007) 17 (2): 17–18. https://doi.org/10.1542/gr.17-2-17 Connected Content A correction has been published: Errata Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Inpatient Management by Hospitalists versus Community Pediatricians. AAP Grand Rounds February 2007; 17 (2): 17–18. https://doi.org/10.1542/gr.17-2-17 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: community, hospitalists, inpatients, asthma Source: Conway HP, Edwards S, Stucky ER, et al. Variations in management of common inpatient pediatric illnesses: hospitalists and community pediatricians. Pediatrics. 2006;118:441–447; doi:10.1542/peds.2006-0484 These authors, from multiple institutions, conducted a national survey to compare the self-reported use among hospitalists and office-based pediatricians of 48 diagnostic and treatment modalities for common inpatient conditions. A total of 198 pediatric hospitalists and 228 randomly selected community pediatricians met inclusion criteria. Survey response rates for hospitalists and community pediatricians were 67% and 15%, respectively. For management of children with urinary tract infections, asthma, bronchiolitis, or gastroenteritis, a total of 12 diagnostic or treatment choices were determined to represent appropriate care based on standards published in BMJ Clinical Evidence or AAP Practice Guidelines. Multivariate regression was performed to assess differences between hospitalists and office-based pediatricians after controlling for the effect of confounding variables including practice in an academic setting and volume of inpatient care. Analysis of survey results found that hospitalists were significantly more likely than office-based pediatricians to report “often” or “almost always” following evidence-based guidelines for using inhaled albuterol, systemic steroids, and inhaled ipratroprium in the first 24 hours for asthma, and for obtaining voiding cystrourethrogram and renal ultrasound for children with a first urinary tract infection. Hospitalists were also more likely to “rarely” or “never” use unproven measures such as levalbuterol for asthma, inhaled and oral steroids for bronchiolitis, and testing for rotavirus or bacterial pathogens for diarrhea. The authors presume that the self-reporting bias of the survey affected both groups evenly, and suggest that hospitalists’ increased self-reports of adherence to evidence-based choices is indicative of delivery of a higher quality of care compared to the community pediatricians in the survey. Previous pediatric studies have demonstrated cost savings and shorter lengths of stay (LOS) in hospitalist systems; however, they did not address more clinically relevant outcomes.1,2 Despite a potential self-reporting bias and a lack of measuring actual clinical outcomes, this article is the first to document a nationwide comparison of pediatric hospitalists and community pediatricians focusing on clinical measures of quality. Dr. Percelay has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. We should not be surprised that focused experience in a particular discipline produces expertise and improved compliance with published guidelines; neonatology and pediatric emergency medicine are excellent examples. Rather than focus on the job description of pediatricians providing inpatient care, perhaps more emphasis should be placed on improving the discipline of pediatric hospital medicine. The authors used odds ratios to quantify differences, but some of the raw percentages of responses to specific items highlight important differences in management decisions. For example, 96% of hospitalists used albuterol for asthma compared to only 85% of office-based pediatricians.3 For a treatment modality with well-established benefit, one would hope that this percentage would be closer to 100%. Demonstration... You do not currently have access to this content.