CURRENT STATE OF AFFAIRS
The field of pediatric hospital medicine has grown rapidly over the past 18 years, since the term “hospitalist” was first coined. The number of hospitalists, including pediatric hospitalists, has increased exponentially and is expected to keep growing.1-4 Numerous pediatric hospital medicine fellowship programs have arisen, producing a new generation of clinician-quality improvement experts and clinician-investigators. Ten years after the first pediatric hospitalist conference, sponsored by the Ambulatory Pediatric Association, which drew more than 120 participants from the United States and Canada, the meeting is now an annual event. Sponsorship comes from the Academy of Pediatrics, the Society of Hospital Medicine, and the Academic Pediatric Association (formerly known as the Ambulatory Pediatric Association, the name change prompted in part by the organization’s recognition of the growth of pediatric hospital medicine). Pediatricians’ organizations have expanded to meet the needs of hospitalists, and hospitalists’ organizations have expanded to meet the needs of their pediatric contingent. The American Academy of Pediatrics Section on Hospital Medicine has one of the largest section memberships in the American Academy of Pediatrics (AAP) and an extremely active listserv; the Academic Pediatric Association Special Interest Group on Pediatric Hospital Medicine is also one of the largest interest groups and has a vital presence at the yearly Pediatric Academic Societies meeting, and the Society of Hospital Medicine (the largest hospitalist organization) continues to foster a home for pediatric hospitalists—several key organizational leadership positions are held by pediatricians. Important research networks and collaboratives have arrived. The Pediatric Research in Inpatient Settings (PRIS; pronounced prize) network is focusing on a series of complementary national funded studies ultimately intended to provide the tools to measure and improve the quality of inpatient care. In addition, the Value in Inpatient Pediatrics (VIP) Network has partnered with the Quality Improvement Innovation Networks (QuINN) to conduct grassroots quality improvement studies engaging clinicians. Finally, pediatric hospitalists are continuing to expand their nonclinical responsibilities to include leadership roles in administration (as division chiefs, medical directors, quality improvement officers, and leaders in patient safety and informatics), research (leading research networks, developing health services research laboratories, and training junior investigators to be competitive in obtaining grants), and education (as clerkship and residency directors).
A tremendous amount of knowledge has been gained from critical early work in the value of pediatric hospitalists in inpatient care delivery. This chapter outlines what we have learned from these early studies, as well as what we still need to learn, and proposes mechanisms to accomplish next steps.
STUDIES ON EFFICIENCY
A substantial number of studies have been conducted on the efficiency of care delivered in pediatric hospitalist models. These studies have been largely single-center studies using before-and-after study designs or interrupted time series analyses. Most (but not all) have found 10–20% shorter length of stay (LOS) and reduced resource utilization (measured as charges or costs) in pediatric hospitalist systems.5-11 The types ...