Advantages and Limitations of the Hospitalist Movement

To the Editor: In their study of the hospitalist movement, Drs Wachter and Goldman¹ stated "although several studies found improved outcomes, such as inpatient mortality and readmission rates, these results were inconsistent." In fact, these are the 2 areas where most of the evidence indicated a lack of advantage by the hospitalist model.

Of the 19 studies described in their table, mortality outcome was not reported in 5 studies, no change in mortality between the groups was observed in 11 studies, 1 study found less mortality in the control group, and only 2 studies reported decreased mortality in patients treated by the hospitalists. Similarly, rates of readmission, from the information provided in the table, in the control and hospitalist groups were not reported in 7 studies, no change in readmission rates were reported in 9 studies, 1 study found higher readmission rates in the hospitalist group, and only 2 studies demonstrated decreased readmission rates in the patients of hospitalists.