Community and hospital-based physicians' attitudes regarding pediatric hospitalist systems

Abstract

Objective: Pediatric hospitalist systems are being implemented widely. Their implementation may be influenced by physician attitudes, which may vary according to practice type (eg, community or hospital-based practice) and personal characteristics (eg, age and practice location). Little evidence exists to describe factors relevant to pediatric systems. The objective of this study was to determine physicians' attitudes regarding hospitalists and associated physician and practice characteristics.

Methods: We used a cross-sectional survey of all physicians with admitting privileges at a tertiary-care, pediatric, teaching hospital in the Intermountain West in April 2002. Outcomes included survey responses indicating attitudes toward the effects of the hospitalist system on quality of care, patient satisfaction, and teaching.

Results: A total of 313 of 368 physicians (85%) responded, 191 of whom (61%) were community physicians; 224 respondents (72%) spent the majority of their time in outpatient care. Community physicians more often characterized inpatient care as an inefficient use of time (45% vs 25%) but were less likely to think that hospitalists would improve the quality of care (49% vs 68%) or increase patient satisfaction (10% vs 30%). In multivariate models examining predictors of overall attitudes toward hospitalists, being a community physician (6.4 points more negative) and admitting patients at >1 hospital (3.3 points more negative) were associated with less favorable attitudes. Being <40 years of age (4.5 points more positive) and practicing >13 miles from the hospital (4.3 points more positive) were associated with more positive attitudes.

Conclusions: Attitudes regarding hospitalist systems differ between physician groups and are influenced by practice characteristics. Understanding these differences and tailoring hospitalist systems to address them will be important as pediatric hospitalist systems are implemented nationwide.