Author: Heather Lynn White
Abstract (summary):Hospitalist physicians have emerged over the past two decades to become dominant providers of inpatient care in North American hospitals. Despite their widespread adoption, quantitative data characterizing the penetration of Canadian hospitalists or their influence on the quality of inpatient care within the Canadian context has not been explored. The primary objectives of this dissertation were to synthesize the existing findings on hospitalist performance, to describe the prevalence and penetration of hospital physicians working in the province of Ontario, and to assess the current performance of physicians practicing general hospital medicine within the province with regards to their clinical effectiveness and operating efficiency. The three papers included in the dissertation demonstrated clear trends that hospital-based physicians are increasingly prevalent in Ontario hospitals and deliver a sizable proportion of the province’s inpatient medical care. Increased inpatient workloads amongst these physicians translated to lower mortality, fewer readmissions and longer lengths of stay for patients under their care. There is a pressing need in Canadian healthcare to improve the processes of acute care provision in order to reduce unnecessary utilization, improve patient safety, and enhance patient experience. Findings in this dissertation provide support for the practice of hospital medicine and concentrated hospital care in Canada, suggesting that high-volume physicians practicing general hospital medicine, including hospitalists, could have a pivotal impact on quality improvement. Research can now turn to understanding the specific practice characteristics and processes of care that differentiate hospital generalists from their colleagues.
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