Hospitalist Efforts and Improving Discharge Planning—Reply

In Reply: We agree with Drs Flansbaum and Williams that the hospitalist movement could make a substantial difference in the care of hospitalized older frail patients. With limited space, we chose not to focus on hospitalists but did reference a recent systematic review that found positive benefits from hospitalists within the hospital and no adverse effects on patients' postdischarge status.¹ However, all the studies reviewed were from 1 hospital or a small number of hospitals. A recent study found that 47.1% of hospitals had at least 3 hospitalists in 2006: 83.7% of teaching hospitals and 38.4% of nonteaching hospitals.² Thus, many hospitalist programs are not part of academic hospitals. Because hospitals are not financially accountable for their patients after discharge, only those hospitals with strong commitments to quality are likely to institute programs designed to ensure continuity of care between hospitalists and patients' primary care physicians. Evidence suggests that hospitalist programs can be effective, but internal changes for efficiency do not assure better outcomes after discharge. We need empirical evidence regarding performance of a representative sample of hospitalist programs, regardless of the sponsorship under which they operate. Assuming that all programs are as effective as the literature may miss important opportunities for improving patients' experiences and outcomes.