Background: Hospitalists at Froedtert Hospital and the Medical College of Wisconsin play a critical role in managing over one-third of the inpatient population, thus having a substantial influence on patient outcomes and overall hospital efficiency. Despite the growing recognition of hospitalist-driven care, the relationship between years of experience and measurable patient and institutional outcomes remains underexplored. This study aimed to evaluate whether hospitalist experience, measured in years, correlates with key performance metrics, including patient outcomes and operational efficiency.
Methods: As part of an ongoing quality improvement initiative, comprehensive data on hospitalist performance including length of stay (LOS), LOS index, mortality, mortality index, 72-hour and 30-day readmissions, patient satisfaction scores, and order set utilization were prospectively collected. Hospitalists (n=100) were categorized into three cohorts based on years of experience: < 2 years, 2-5 years, and >5 years. The patient records reviewed spanned from January 1, 2023, to December 31, 2023, with a focus on cases with complete HCAPHS satisfaction data. Data analysis utilized descriptive statistics (mean ± standard deviation for continuous variables, counts and percentages for categorical variables), two-sample t-tests, chi-square tests, and correlation analyses to explore potential associations. Regression models, both linear and logistic, were adjusted for relevant covariates. Mixed-effects models accounted for the hierarchical nature of the data. Statistical significance was defined as p< 0.05.
Results: The analysis of 515 patient charts with complete satisfaction data revealed no statistically significant association between hospitalist years of experience and any patient or hospital outcome metrics. The cohorts of hospitalists included 24 with < 2 years of experience, 20 with 2-5 years, and 15 with >5 years of experience. Across all groups, outcomes such as 72-hour readmission rates (97.67%), 30-day readmission rates (87.77%), inpatient mortality (79.42%), and high patient satisfaction scores (67.38% for scores of 9-10) were not significantly different. These findings persisted across multiple outcome measures, including LOS and readmission rates.
Conclusions: This study found no evidence to suggest a correlation between hospitalist experience and key patient or hospital outcomes. Several limitations may have influenced these findings. Notably, the analysis was restricted to patients who completed satisfaction surveys, introducing potential selection bias. The single-institution setting may also limit the broader applicability of the results. Moreover, non-clinical responsibilities, such as administrative duties and research commitments, particularly for hospitalists with >5 years of experience, were not accounted for. The relatively short duration of the study (one year) may have constrained the ability to detect long-term trends. Furthermore, unmeasured confounding variables, including hospitalist burnout, full-time equivalent status, the lingering effects of COVID-19, and dynamics within family and care teams, were not captured. Future multi-institutional longitudinal research incorporating these factors is warranted to clarify the influence of hospitalist experience on clinical outcomes and to explore potential periods of professional plateau or decline that may necessitate targeted interventions for sustained professional development.