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Defining hospitalist physicians using clinical practice data: a systems level pilot study of Ontario physicians.
Today, Open Medicine <http://www.openmedicine.ca/> published a study in which the authors propose and apply a functional method to identify hospital-based physicians and describe the growth and prevalence of a relatively new but poorly-defined specialty—that of hospital-based practice.
In the province of Ontario, hospital-based physicians have grown in number since cutbacks to physician reimbursement during the mid-1990s led to an exodus of primary care physicians and consequent recruitment and contracting of family physicians by individual hospitals. But without a single definition of hospitalists, it has not been possible to track just how many there are, or to characterize their practice. More critically, it has been impossible to evaluate whether the hospitalist movement has led to improvements in either efficiency or quality of care.
In the present study, the authors used a novel method to identify and characterize hospitalists, combining volume of inpatient care derived from OHIP billings and telephone survey follow-ups with other practice data derived from the ICES Physician Database, which contains demographic and practice data for Ontario-licensed physicians. The idea was to better define hospital-based physicians while recognizing different specialties within hospital-based practice and distinguishing between part-time, low-volume and full-time, high-volume hospital-based practitioners.
“It gives us a good picture of who’s providing care and how much,” says Heather White, lead author of the study.
Indeed, the authors found that there has been a significant increase in full-time general hospitalists since 2000/2001. They also found that there has been an associated decrease in the numbers of high-volume internists and specialists.
“We now have an opportunity and a framework to start tracking the outcomes, which is ultimately what we want to know,” says White.
“What turns out to be the best model for patient care is the next question.”
For more information, please visit Open Medicine <http://www.openmedicine.ca/article/view/581/516
Heather L. White, MSc, is a PhD candidate at the Institute of Health Policy, Management and Evaluation, University of Toronto, and a student at the Institute for Clinical Evaluative Sciences, Toronto, Ontario. Thérèse A. Stukel, PhD, is a Senior Scientist at the Institute for Clinical Evaluative Sciences, Toronto, Ontario; an Adjunct Professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; and a Professor at the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario. Walter P. Wodchis, PhD, is an Associate Professor at the Institute of Health Policy, Management and Evaluation, University of Toronto; an Adjunct Scientist at the Institute for Clinical Evaluative Sciences; and a Scientist at the Toronto Rehabilitation Institute, Toronto, Ontario. Richard H. Glazier, MD, MPH, FCFP, is a Senior Scientist at the Institute for Clinical Evaluative Sciences; a Professor at the Institute of Health Policy, Management and Evaluation and the Department of Family and Community Medicine, University of Toronto; a Scientist at the Centre for Research on Inner City Health in the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital; and a Clinician Scientist and Family Physician in the Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario.
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