Background: In the US, hospitalist system has been introduced with improvement of quality and safety of care, education and value. Japan now face rapidly declining birthrate and aging population. Organ-based subspecialty system has difficulty in managing patients with multiple diseases. Patient-centered general medical care is required for inpatient management. However, in Japan, there are only a few hospitals that introduced hospitalist system and its effectiveness about quality of care has not been examined.
Methods: We conducted a comparative study before and after implementation of hospitalist system in a community teaching hospital in Japan by examining quality of care about patients admitted for pneumonia. Inclusion criteria were adult patients hospitalized with community acquired pneumonia at Urasoe General Hospital between April 2018 and April 2019. Exclusion criteria were patients with baseline interstitial pneumonia. Primary endpoints were mortality rate during hospitalization and readmission rate within 3 months after discharge. Secondary endpoints were the length of hospital stay, pneumococcal vaccination rate, and antibiotic treatment period.
Results: There were 41 hospitalized patients with pneumonia during the study period. Between pre- and post-implementation of hospitalist system, both in-hospital mortality and readmission rate were not significantly different. However, mean hospital stay was significantly shorter in the post-implementation group (mean days 12.5, 95% CI [4, 25], p <0.001), and mean duration of antibiotic administration were also significantly reduced (mean days 8.4, 95% CI [5, 14], p <0.001). In addition, pneumococcal vaccination rate increased significantly in the post-implementation group (vaccination rate 19%, p <0.001).
Conclusions: Our study is the first to prove that several measures about quality of inpatient care improved by introducing hospitalist system in a community teaching hospital in Japan.