Evidence-Based Evaluation of the Hospitalist Model of Care

Most health care professionals now recognize a hospitalist as a physician who dedicates 25% or more of his or her time to the practice of inpatient medicine and who manages the care of hospitalized patients for primary care physicians [1,2]. The National Association of Inpatient Physicians (NAIP) estimates there are currently 3000 to 4000 practicing hospitalists in the United States; this number is expected to increase, as 1999 hospital census data support as many as 30,000 hospitalist positions [3]. As the U.S. medical system continues to embrace the use of hospitalists, there are still many questions regarding the efficacy and benefit of this model of care. To facilitate discussion and comparison of the different care models, including hospitalist versus nonhospitalist models, it is useful to refer to Wachter’s 4-stage model of hospital care (Table 1) [2,4]. Wachter classifies hospital care into the primary care stage (I), hospital rotation stage (II), voluntary hospitalist stage (III), and mandatory hospitalist stage (IV). This article will endeavor to answer some key questions regarding outcomes associated with hospitalist care (stages III and IV) through a review of the literature.