Hospitalist programs are changing inpatient care in academic medical centers across the nation. Some question whether these programs will experience disparities based on race, age, gender, and economic status compared to traditional internal medicine services. We compared patients of traditional teaching (TT) and traditional non-teaching (TNT) services to hospitalist teaching (HT) and hospitalist non-teaching (HNT) services at one academic medical center. In 2000, the HNT replaced the TNT. Patient characteristics examined included age (youth, early adult, later adult, older adult, aged adult), race (black, white, other), gender, and insurance type (HMO, indigent, Medicaid, Medicare, private). We calculated chi-square comparisons of the hospitalists services to non-hospitalists services. Admissions to all services were from a semi-random admission algorithm. Hospitalists managed 781 of the 3040 discharges. For the year 2000, comparing hospitalist services to non-hospitalist services, there were no differences in patients based on age, race, gender, or insurance coverage. For the medical center, contrasting 1999 to 2000, the only overall difference in patients was insurance status (p<0.01). Comparing the TNT in 1999 to the HNT in 2000 there were significant differences in race (p=.0009) and insurance status (p=0.0005). Results indicate that adverse selection has not become an issue for hospitalist programs in this academic medical center. Although academic medical centers may be serving a population with less access to health insurance, low-income, minority patients are not assigned less often to hospitalist care. Thus. access to this new, innovative, more supportive type of inpatient care was available to vulnerable populations.
Learning Objectives: At the conclusion of the session, the participant will be able to: 1. describe a hospitalist and a hospitalist program 2. discuss the advantages and disadvantages of a hospitalist program especially for vulnerable populations 3. describe patients' access to a hospitalist program at an academic medical center based on race, gender, age, and insurance status.
Keywords: Hospitals, Access to Health Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.