Moments in Time

Editorials2 August 2011Moments in TimeLena M. Chen, MD, MS and Sanjay Saint, MD, MPHLena M. Chen, MD, MSFrom Hospital Outcomes Program of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48109.Search for more papers by this author and Sanjay Saint, MD, MPHFrom Hospital Outcomes Program of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48109.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-3-201108020-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail “You cannot step into the same river twice.”—Heraclitus (as reported by Plato)Although it seems hard to imagine, it was not that long ago that U.S. hospitals played little role in the lives of the ill. In 1873, there were fewer than 200 hospitals in the United States (1). Most people (and most physicians for that matter) would be born, live, and die without ever seeing a hospital, much less setting foot in one (1). But the next few decades saw a radical transformation in health care. By the early 20th century, there were nearly 4400 hospitals in the United ...References1. Rosenberg CE. The Care of Strangers: The Rise of America's Hospital System. Baltimore: Johns Hopkins Univ Pr; 1995. Google Scholar2. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335:514-7. [PMID: 8672160] CrossrefMedlineGoogle Scholar3. Kuo YF, Sharma G, Freeman JL, Goodwin JS. Growth in the care of older patients by hospitalists in the United States. N Engl J Med. 2009;360:1102-12. [PMID: 19279342] CrossrefMedlineGoogle Scholar4. Coffman J, Rundall 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;62:379-406. [PMID: 16049131] CrossrefMedlineGoogle Scholar5. Peterson MC. A systematic review of outcomes and quality measures in adult patients cared for by hospitalists vs nonhospitalists. Mayo Clin Proc. 2009;84:248-54. [PMID: 19252112] CrossrefMedlineGoogle Scholar6. Frustrations with hospitalist care: need to improve transitions and communication [Editorial]. Ann Intern Med. 2010;152:469. [PMID: 20368654] LinkGoogle Scholar7. Kuo YF, Goodwin JS. Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study. Ann Intern Med. 2011;155:152-9. LinkGoogle Scholar8. Chang CH, Stukel TA, Flood AB, Goodman DC. Primary care physician workforce and Medicare beneficiaries' health outcomes. JAMA. 2011;305:2096-104. [PMID: 21610242] CrossrefMedlineGoogle Scholar9. Harrison ML, Graff LA, Roos NP, Brownell MD. Discharging patients earlier from Winnipeg hospitals: does it adversely affect quality of care? CMAJ. 1995;153:745-51. [PMID: 7664228] MedlineGoogle Scholar10. McCormick D, Fine MJ, Coley CM, Marrie TJ, Lave JR, Obrosky DS, et al. Variation in length of hospital stay in patients with community-acquired pneumonia: are shorter stays associated with worse medical outcomes? Am J Med. 1999;107:5-12. [PMID: 10403346] CrossrefMedlineGoogle Scholar11. Cleary PD, Greenfield S, Mulley AG, Pauker SG, Schroeder SA, Wexler L, et al. Variations in length of stay and outcomes for six medical and surgical conditions in Massachusetts and California. JAMA. 1991;266:73-9. [PMID: 2046132] CrossrefMedlineGoogle Scholar12. Hackbarth G, Reischauer R, Mutti A. Collective accountability for medical care—toward bundled Medicare payments. N Engl J Med. 2008;359:3-5. [PMID: 18596270] CrossrefMedlineGoogle Scholar13. Hussey PS, Sorbero ME, Mehrotra A, Liu H, Damberg CL. Episode-based performance measurement and payment: making it a reality. Health Aff (Millwood). 2009;28 5 1406-17. [PMID: 9738258] CrossrefMedlineGoogle Scholar14. Saint S, Flanders SA. Hospitalists in teaching hospitals: opportunities but not without danger [Editorial]. J Gen Intern Med. 2004;19:392-3. [PMID: 15061750] CrossrefMedlineGoogle Scholar15. Vasilevskis EE, Knebel RJ, Wachter RM, Auerbach AD. California hospital leaders' views of hospitalists: meeting needs of the present and future. J Hosp Med. 2009;4:528-34. [PMID: 20013852] CrossrefMedlineGoogle Scholar16. Meltzer DO, Chung JW. U.S. trends in hospitalization and generalist physician workforce and the emergence of hospitalists. J Gen Intern Med. 2010;25:453-9. [PMID: 20352367] CrossrefMedlineGoogle Scholar17. Saint S, Zemencuk JK, Hayward RA, Golin CE, Konrad TR, Linzer M; SGIM Career Satisfaction Group. What effect does increasing inpatient time have on outpatient-oriented internist satisfaction? J Gen Intern Med. 2003;18:725-9. [PMID: 12950481] CrossrefMedlineGoogle Scholar18. McMahon LF. The hospitalist movement—time to move on [Editorial]. N Engl J Med. 2007;357:2627-9. [PMID: 18094384] CrossrefMedlineGoogle Scholar19. Pham HH, Grossman JM, Cohen G, Bodenheimer T. Hospitalists and care transitions: the divorce of inpatient and outpatient care. Health Aff (Millwood). 2008;27:1315-27. [PMID: 18780917] CrossrefMedlineGoogle Scholar20. Saint S, Konrad TR, Golin CE, Welsh DE, Linzer M; SGIM Career Satisfaction Study Group. Characteristics of general internists who practice only outpatient medicine: results from the physician worklife study. Sem Med Pract. 2002;5:5-11. [PMID: 2950481] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Hospital Outcomes Program of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48109.Acknowledgment: The authors thank Drs. Scott Flanders, Joel Howell, and Larry McMahon for reviewing an earlier version of this manuscript.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1404.Corresponding Author: Lena M. Chen, MD, MS, Division of General Medicine, University of Michigan, 300 North Ingalls, Room 7E02, Ann Arbor, MI 48109-0429; e-mail, [email protected]edu.Current Author Addresses: Dr. Chen: Division of General Medicine, University of Michigan, 300 North Ingalls Street, Room 7E02, Ann Arbor, MI 48109-0429.Dr. Saint: Division of General Medicine, University of Michigan, 300 North Ingalls Street, Room 7D21, Box 5429, Ann Arbor, MI 48109-5429. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study Yong-Fang Kuo and James S. Goodwin Metrics 2 August 2011Volume 155, Issue 3Page: 194-195KeywordsHealth careHospitalistsHospitalizationsInpatientsMedicareOutpatient clinicsOutpatientsPatients ePublished: 2 August 2011 Issue Published: 2 August 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. 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