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Periodic Survey #52 Attitudes Toward and Experiences with Pediatric Hospitalists

PERIODIC SURVEY OF FELLOWS

American Academy of Pediatrics

Division of Health Services Research

EXECUTIVE SUMMARY


This survey addressed pediatricians' attitudes toward and experiences with pediatric hospitalists. The survey was initiated by the Section on Hospital Care to explore the extent to which pediatric hospitalist practice has developed, reasons for referrals to in-patient pediatricians by primary care pediatricians, and pediatricians' experiences and satisfaction with the pediatric hospitalist system.

Periodic Survey #52 was an eight-page self-administered questionnaire sent to 1,626 active United States members from April through August 2002. After six mailings we received a total of 965 completed questionnaires for a response rate of 59%. There were 654 eligible pediatricians who provide direct patient care in an office or clinic-based setting: this represents 68% of all pediatricians. Respondents were provided with a definition of the term "hospitalist" as well as an instruction to answer the questions in reference to patients hospitalized on the pediatric ward and not to patients hospitalized in the nursery or an intensive care unit. 



Overall Findings:

Utilization of pediatric hospitalists by pediatricians varies. Pediatricians' and perceived patient satisfaction with the level of care provided by hospitalists are high. There is also general agreement that use of hospitalists increases the manageability and productivity of office practice. However, there is no consensus of opinion on the effect of pediatric hospitalists on continuity or coordination of care and involvement of primary care pediatricians in inpatient management.


Availability of Pediatric Hospitalists (N=637)

  • 40% of pediatricians are affiliated with hospitals that employ full-time pediatric hospitalists to care for patients on the general pediatric ward.


Referrals to Pediatric Hospitalists (N=252) 

  • Pediatricians with full-time pediatric hospitalists available at their hospital report an average of 45% of their general pediatric ward hospitalized patients per month are cared for by a hospitalist.
    • 40% of pediatricians with access to pediatric hospitalists do not refer any patients to hospitalists; 38% say they refer all of their hospitalized patients to pediatric hospitalists; the balance, 22%, say they refer some patients.


Reasons for Referrals to Pediatric Hospitalists (N=158)

  • Among pediatricians who use pediatric hospitalists, the reasons given for transferring the care of hospitalized patients include:
    • Hospitals report an average of 45% of their general pediatric ward hospitalized patients per month are cared for by a hospitalist.
    • Belief that hospitalists can provide the best care for their patients due to their full-time availability (61%).
    • Belief that hospitalists provide the best care due to their experience working with hospitalized children (53%).
    • Attending inpatients takes too much time away from office practice (53%).hospitalized patients to pediatric hospitalists; the balance, 22%, say they refer some patients.
    • Prefer concentrating on ambulatory pediatrics (37%).
    • Hospital or managed care organization requirements (26%).
    • Low reimbursement for inpatient care (21%).
    • Discomfort managing hospitalized patients (17%).


Experiences with Pediatric Hospitalists (N=158)

  • Most pediatricians agree that using a hospitalist makes office practice more predictable and manageable (78%) and reduces the burden of being on call (70%).
  • 59% of pediatricians say using a hospitalist limits their ability to maintain inpatient skills and 44% agree it limits participation in major inpatient management decisions; 23% are unsure about both of these potential limitations.
  • More than half of pediatricians (54%) do not think use of pediatric hospitalists diminishes career satisfaction due to the limited direct involvement in the care of hospitalized patients, while 20% thinks it does.
  • 43% each of pediatricians say using a hospitalist facilitates their ability to develop expertise in aspects of ambulatory care and improves their career satisfaction by allowing them to specialize in ambulatory pediatrics; a nearly equal proportion is uncertain of hospitalists' effect on these areas.

Effects of Using Hospitalists: (N=158)

  • Pediatricians do not think use of hospitalists has any effect on income (81%) or quality of relationships with patients (77%).
  • Two-thirds of pediatricians (68%) believe the use of hospitalists increases the overall quality of patient care and 57% say it increases office productivity.ree it limits participation in major inpatient management decisions; 23% are unsure about both of these potential limitations.
  • 35% of pediatricians believe using hospitalists has no effect on the coordination of care between inpatient and outpatient settings; 35% say it decreases coordination of care, while 30% of pediatricians believe it positively effects coordination of care.
  • 45% of pediatricians think use of hospitalists decreases continuity of care, although 30% say it has no effect and 25% think it increases continuity of care.

Satisfaction with Pediatric Hospitalist System (N=158)

  • Most pediatricians are satisfied with the care provided by pediatric hospitalists (60% say "very satisfied" and 27% say "satisfied") and their overall experiences with their local pediatric hospitalist program (54% say "very satisfied" and 32% say "satisfied").
  • 8 out of 10 pediatricians believe their patients are also satisfied with the care provided by pediatric hospitalists (43% say "very satisfied" and 40% say "satisfied").
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