Quality of Care for Patients Hospitalized With Heart Failure

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Abstract
HEART FAILURE affects some 5 million Americans1 and results in approximately 200 000 deaths each year. It is the leading cause of hospital admission among Medicare beneficiaries, with annual costs estimated to exceed $20 billion. Measured against standards developed from clinical practice guidelines from the Agency for Healthcare Research and Quality, the American Heart Association (AHA), and the Advisory Council to Improve Outcomes Nationwide in Heart Failure,1-3 the quality of care for patients with heart failure has been shown to vary by physician, hospital, and region.4-7 In light of these findings, improving the quality of care for patients hospitalized with heart failure has been a high priority for the Health Care Financing Administration's (HCFA's) Medicare program as well as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).8,9 Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients.10 In settings ranging from large academic medical centers to small community-based hospitals, hospitalists are playing an expanding role in providing care for hospitalized children and adults.11-15 A recent workforce projection predicted that the field may ultimately grow to as many as 10 000 to 30 000 and that hospitalists may eventually come to dominate the inpatient care arena.16 As a result of the enormous financial pressures facing many American hospitals, much of the early interest in hospitalists has focused on their potential role in reducing length of stay and lowering costs.13,17 There has been less attention paid to the effect of hospitalists on quality of care, and evidence addressing this topic is limited.18 Because the growth of the hospitalist model carries major implications for the care of patients with chronic illnesses such as heart failure, we sought to determine whether the quality or costs of care for patients with heart failure, as measured by a variety of process and outcome measures, differed between hospitalists and their nonhospitalist generalist colleagues.

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