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Rebuttal

Rebuttal Quibbling over definitions instead of evaluating the evidence cannot conceal the growing and increasingly irrefutable evidence demonstrating that hospitalists deliver quality care and do it more cost-effectively than outpatient-based internists.1,2Practicing outpatient internists also seem pleased with the evolution of hospitalists.3As the fastest growing specialty in the history of health care, hospital medicine continues to evolve with multiple descriptions of various models in both academic and community settings now being published and more recent research showing hospitalists delivering higher quality care for common conditions requiring hospitalization. In addition, hospitalists also seem to be preferred academic educators in the hospital for both residents and medical students.4,5Although some academicians continue to hold out, yearning for the good old days, the American Board of Internal Medicine (ABIM) now recognizes that hospital medicine deserves special recognition.6 No valid reason exists to continue debating whether hospitalists focused on improving the system of hospital care will be the future of care delivery in hospitals. With more than 20 000 hospitalists in the United States and growth projections as high as 50 000 in the next decade, we should focus our efforts on determining how hospitalists can best collaborate with their colleagues. Hospitalists need to establish teamwork-based models involving nurses, pharmacists, and others inside hospitals. Hospitalists also should reach out to their partners in the outpatient setting to optimize communication of essential information. Thankfully, organizations such as the Society of Hospital Medicine (SHM), American College of Physicians, Society of General Internal Medicine, American College of Emergency Physicians, and ABIM are actively working on initiatives to establish standards for transitions of care. I hope my colleague will focus on how hospitalists might provide the best care for patients when they are hospitalized, instead of wistfully opining for the survival of “complete” internists. Personally, I no longer feel confident handling the complexity of managing patients with multiple chronic illnesses in the outpatient setting. Likewise, we need to have focused training of “physicians whose primary professional focus is the general medical care of hospitalized patients . . . ” (the definition of hospitalists by the SHM7). To improve hospital care delivery will require outpatient physicians to actively engage in the transfer of patients' core health care information to hospitalists at the time of admission while remaining available for communication throughout a patient's hospitalization. Likewise, hospitalists must ensure that they hand off care and seamlessly convey necessary materials to the PCP when patients make the transition from the hospital back to their homes or a skilled nursing facility. Hopefully, payers will reimburse such communication efforts. By working together, we will provide patients the best care they deserve should they require hospitalization. References 1. Coffman JRundall TG The impact of hospitalists on the cost and quality of inpatient care in the United States: a research synthesis. Med Care Res Rev 2005;62 (4) 379- 406PubMedGoogle ScholarCrossref 2. Wachter RMGoldman L The hospitalist movement 5 years later. JAMA 2002;287 (4) 487- 494PubMedGoogle ScholarCrossref 3. Auerbach ADAronson MDDavis RBPhillips RS How physicians perceive hospitalist services after implementation: anticipation vs reality. Arch Intern Med 2003;163 (19) 2330- 2336PubMedGoogle ScholarCrossref 4. Hunter AJDesai SSHarrison RAChan BKS Medical student evaluation of the quality of hospitalist and nonhospitalist teaching faculty on inpatient medicine rotations. Acad Med 2004;79 (1) 78- 82PubMedGoogle ScholarCrossref 5. Kripalani SPope ACRask K et al. Hospitalists as teachers. J Gen Intern Med 2004;19 (1) 8- 15PubMedGoogle ScholarCrossref 6. Wachter RM What will board certification be and mean for hospitalists? J Hosp Med 2007;2 (2) 102- 104PubMedGoogle ScholarCrossref 7. Society of Hospital Medicine Web site. http://www.hospitalmedicine.org/AM/Template.cfm?Section=FAQs&Template=/FAQ/FAQSearchResult.cfm#1. Accessed April 8, 2008 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Rebuttal

Williams, Mark V.
Archives of Internal Medicine , Volume 168 (12) – Jun 23, 2008
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Rebuttal

Abstract

Quibbling over definitions instead of evaluating the evidence cannot conceal the growing and increasingly irrefutable evidence demonstrating that hospitalists deliver quality care and do it more cost-effectively than outpatient-based internists.1,2Practicing outpatient internists also seem pleased with the evolution of hospitalists.3As the fastest growing specialty in the history of health care, hospital medicine continues to evolve with multiple descriptions of various models in both...
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References (7)

Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.168.12.1259
Publisher site
See Article on Publisher Site

Abstract

Quibbling over definitions instead of evaluating the evidence cannot conceal the growing and increasingly irrefutable evidence demonstrating that hospitalists deliver quality care and do it more cost-effectively than outpatient-based internists.1,2Practicing outpatient internists also seem pleased with the evolution of hospitalists.3As the fastest growing specialty in the history of health care, hospital medicine continues to evolve with multiple descriptions of various models in both academic and community settings now being published and more recent research showing hospitalists delivering higher quality care for common conditions requiring hospitalization. In addition, hospitalists also seem to be preferred academic educators in the hospital for both residents and medical students.4,5Although some academicians continue to hold out, yearning for the good old days, the American Board of Internal Medicine (ABIM) now recognizes that hospital medicine deserves special recognition.6 No valid reason exists to continue debating whether hospitalists focused on improving the system of hospital care will be the future of care delivery in hospitals. With more than 20 000 hospitalists in the United States and growth projections as high as 50 000 in the next decade, we should focus our efforts on determining how hospitalists can best collaborate with their colleagues. Hospitalists need to establish teamwork-based models involving nurses, pharmacists, and others inside hospitals. Hospitalists also should reach out to their partners in the outpatient setting to optimize communication of essential information. Thankfully, organizations such as the Society of Hospital Medicine (SHM), American College of Physicians, Society of General Internal Medicine, American College of Emergency Physicians, and ABIM are actively working on initiatives to establish standards for transitions of care. I hope my colleague will focus on how hospitalists might provide the best care for patients when they are hospitalized, instead of wistfully opining for the survival of “complete” internists. Personally, I no longer feel confident handling the complexity of managing patients with multiple chronic illnesses in the outpatient setting. Likewise, we need to have focused training of “physicians whose primary professional focus is the general medical care of hospitalized patients . . . ” (the definition of hospitalists by the SHM7). To improve hospital care delivery will require outpatient physicians to actively engage in the transfer of patients' core health care information to hospitalists at the time of admission while remaining available for communication throughout a patient's hospitalization. Likewise, hospitalists must ensure that they hand off care and seamlessly convey necessary materials to the PCP when patients make the transition from the hospital back to their homes or a skilled nursing facility. Hopefully, payers will reimburse such communication efforts. By working together, we will provide patients the best care they deserve should they require hospitalization. References 1. Coffman JRundall TG The impact of hospitalists on the cost and quality of inpatient care in the United States: a research synthesis. Med Care Res Rev 2005;62 (4) 379- 406PubMedGoogle ScholarCrossref 2. Wachter RMGoldman L The hospitalist movement 5 years later. JAMA 2002;287 (4) 487- 494PubMedGoogle ScholarCrossref 3. Auerbach ADAronson MDDavis RBPhillips RS How physicians perceive hospitalist services after implementation: anticipation vs reality. Arch Intern Med 2003;163 (19) 2330- 2336PubMedGoogle ScholarCrossref 4. Hunter AJDesai SSHarrison RAChan BKS Medical student evaluation of the quality of hospitalist and nonhospitalist teaching faculty on inpatient medicine rotations. Acad Med 2004;79 (1) 78- 82PubMedGoogle ScholarCrossref 5. Kripalani SPope ACRask K et al. Hospitalists as teachers. J Gen Intern Med 2004;19 (1) 8- 15PubMedGoogle ScholarCrossref 6. Wachter RM What will board certification be and mean for hospitalists? J Hosp Med 2007;2 (2) 102- 104PubMedGoogle ScholarCrossref 7. Society of Hospital Medicine Web site. http://www.hospitalmedicine.org/AM/Template.cfm?Section=FAQs&Template=/FAQ/FAQSearchResult.cfm#1. Accessed April 8, 2008

Journal

Archives of Internal Medicine – American Medical Association

Published: Jun 23, 2008

Keywords: hospitalists,outpatients,hospital care,transfer technique,pentachlorophenol,pneumonia, pneumocystis carinii,phencyclidine

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