Health system drivers of hospital medicine in Canada: systematic review.

OBJECTIVE To identify the underlying systemic drivers of the development and ongoing expansion of hospitalist programs in Canada. DATA SOURCES MEDLINE and Google Scholar were searched using combinations of the terms hospitalist, hospital medicine, and Canada. STUDY SELECTION All publications that addressed the study question, including review articles, original research, editorials, commentaries, and letters or news articles, were included in the review. SYNTHESIS Constant comparative methodology was used to analyze and code the articles and to synthesize the identified codes into broader themes. Three broad categories were identified: physician-related drivers, health system-related drivers, and patient-related drivers. Within each category, we identified a number of drivers. CONCLUSION Many drivers have been cited in the literature as reasons behind the emergence and growth of the hospitalist model in the Canadian health care system. While their interplay makes simple cause-and-effect conclusions difficult, these drivers demonstrate that hospitalist programs in Canada have developed in response to a complex set of provider, system, and patient factors.