‘Physician advocates’: a novel strategy for improving the value of hospital care by employing hospitalists part time to support non-hospitalist physicians

ABSTRACT

Background and Objective

At many hospitals, private-practice physicians still admit their own patients and are accustomed to autonomy in clinical practice. This creates challenges for hospital’s efforts to improve the efficiency, quality, and value of care. Experienced inpatient-focused physicians – ‘Physician Advocates’ – could act as liaisons between private practitioners and the fast-paced inpatient microsystem.

Methods

We conducted a controlled pre-post (‘differences-in-differences’) analysis at an academic medical center where private-practice physicians care for about 40% of medical inpatients and hospitalist groups care for 60%. In the intervention, ‘Physician Advocates’ participated in daily multidisciplinary ‘Progression of Care Rounds,’ offering suggestions to increase care quality for private-practice physicians’ patients. Controls were cared for by a large, well-established hospitalist group, which convened separate, unchanged multidisciplinary rounds. Outcomes were length of stay (LOS; primary outcome), 30-day readmissions, and inpatient mortality.

Results

In a risk-adjusted analysis of 31,632 medical inpatients, LOS declined by 4 hours more from the baseline period to the post-intervention period in the intervention group relative to the control group (ratio: 0.96, 95% CI: 0.93–0.99, p = 0.004). Readmissions declined 22% more in the intervention group (OR: 0.78, 95% CI: 0.63–0.97, p = 0.023). Mortality was unchanged (OR: 1.23, 95% CI: 0.78–1.93 p-value = 0.378).

Conclusion

Among inpatients cared for by private practitioners, adding Physician Advocates to multidisciplinary rounds was associated with improved LOS and reduced readmissions – measures of efficiency and value. The Physician Advocates approach should be tested in diverse health systems because it allows hospitals to leverage the expertise of on-site clinicians while respecting the traditional private-practice care model, in which primary care physicians manage their hospitalized patients.

KEYWORDS:

• Quality improvement
• hospital medicine
• interdisciplinary communication
• hospital-physician relations
• professional autonomy
• length of stay
• hospital readmissions

Acknowledgments

We would like to acknowledge the contributions of the following individuals to the conduct of the intervention or completion of the analysis: Scott Weingarten, MD and Bradley Rosen, MD.

Disclosure of financial/other conflicts of interest

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors have no funding to report.