Background: The hospitalist system in Korea was introduced to address gaps in inpatient care and enhance safety. Despite increasing demand, research on the impact of hospitalists’ years of experience on care quality remains limited.
Methods: A retrospective cohort study was conducted in multiple tertiary centers with inpatient internal medicine hospitalist wards. Hospitalists who began working between March 2017 and December 2020 and remained at the same institution for at least two years were included. Among 31 hospitalists, 18 met the criteria. During the hospitalists’ work period, patients admitted to hospitalist wards via the emergency department from March 2017 to December 2022 were included. A total of 4,958 patients (mean age 68.85±15.39 years, 57.70% male) were analyzed. Outcomes assessed were in-hospital death, 30-day ER visits, 30-day readmissions, 90-day ER visits, and 90-day readmissions. Adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using multivariable logistic regression, adjusting for age, sex and Charlson Comorbidity Index (CCI).
Results: Patients were categorized based on the hospitalists’ years of experience: 1 year (n=1,338; 26.99%), 2 years (n=1,382; 27.87%), 3 years (n=1,183; 23.86%), and ≥4 years (n=1,055; 21.28%). There were no significant differences in age, sex, BMI, comorbidities, and mean CCI scores among the groups (Table 1). Hospitalists with more experience demonstrated reduced risks of ER visits and readmissions. For 30-day ER visits, hospitalists with 2, 3, and ≥4 years of experience had adjusted ORs of 0.69 (95% CI, 0.57–0.85), 0.57 (95% CI, 0.46–0.71), and 0.56 (95% CI, 0.45–0.70), respectively. A similar trend was observed for 30-day readmissions, with adjusted ORs of 0.59 (95% CI, 0.48–0.73), 0.50 (95% CI, 0.40–0.63), and 0.38 (95% CI, 0.30–0.49), respectively. For 90-day ER visits and readmissions, hospitalists with more than 2 years of experience also demonstrated significantly reduced risks (Figure 1). However, for in-hospital death, hospitalists with ≥4 years of experience had a significantly higher adjusted OR (1.42 [95% CI, 1.09–1.85]) compared to those with 1 year.
Conclusions: Increased hospitalist experience is associated with reduced risks of ER visits and readmissions, underscoring the importance of retaining experienced hospitalists to improve the quality of inpatient care and alleviate the burden on emergency departments.
