Hospitalist Systems Community and Hospital-Based Physicians' Attitudes Regarding Pediatric

ABSTRACT. Objective. Pediatric hospitalist systemsare being implemented widely. Their implementationmay be influenced by physician attitudes, which mayvary according to practice type (eg, community or hospi-tal-based practice) and personal characteristics (eg, ageand practice location). Little evidence exists to describefactors relevant to pediatric systems. The objective of thisstudy was to determine physicians’ attitudes regardinghospitalists and associated physician and practice char-acteristics. Methods. We used a cross-sectional survey of all phy-sicians with admitting privileges at a tertiary-care, pedi-atric, teaching hospital in the Intermountain West inApril 2002. Outcomes included survey responses indicat-ing attitudes toward the effects of the hospitalist systemon quality of care, patient satisfaction, and teaching. Results. A total of 313 of 368 physicians (85%) re-sponded, 191 of whom (61%) were community physi-cians; 224 respondents (72%) spent the majority of theirtime in outpatient care. Community physicians more of-ten characterized inpatient care as an inefficient use oftime (45% vs 25%) but were less likely to think thathospitalists would improve the quality of care (49% vs68%) or increase patient satisfaction (10% vs 30%). Inmultivariate models examining predictors of overall atti-tudes toward hospitalists, being a community physician(6.4 points more negative) and admitting patients at >1hospital (3.3 points more negative) were associated withless favorable attitudes. Being 13 miles from thehospital (4.3 points more positive) were associated withmore positive attitudes.