Hospitalists能改善住院照護成果嗎？

Do Hospitalists Improve the Outcomes of Inpatient Care?

汪秀玲(Hsiu-Ling Wang)

《台灣醫學》 23卷2期 (2019/03) Pp. 269-274

https://doi.org/10.6320/FJM.201903_23(2).0015

摘要

Hospitalists physician（HP）模式發展迄今20多年，關於HP能否改善照護品質未有定論，本文藉由國際研究文獻回顧，綜論HP對照護成果之實證影響。搜尋PubMed及Medline資料庫2018年5月以前英語發表於同儕審查期刊，以Hospitalists [Title] OR（hospital-based physicians [Title] OR hospital medicine [Title]）為檢索策略，限縮文章類型為系統性回顧systematic review或統合分析，17篇文獻中排除4篇社論或描述性論文，並篩選著重照護成果主題文獻，有7篇符合研究目的，摘錄研究特徵、照護成果之比較分析，綜述HP制度照護品質。多數研究於美國地區進行，整體而言，相對傳統醫師，HP在效率上縮短住院天數、降低醫療費用等表現較優，並且不會對臨床結果產生不利影響；某些研究認為，住院天數縮短但費用沒有顯著差異，HP在照護品質（如死亡率）或病人滿意度沒有顯著差異。HP是住院照護的有效率提供者，HP的臨床品質似乎與傳統模式相當，未來研究應延伸探討HP照護結構，以衡量驅動HP照護成果潛在機制。

關鍵字

醫院整合醫療主治醫師 ； 照護成果 ； 文獻回顧 ； 統合分析

並列摘要

Although two decade of studies on the performance of hospitalists physician (HP) programs, disagreement still exists regarding whether HP improves inpatient care quality. This review summarizes the findings from comparative evaluations to explore the outcomes of inpatient care of HP provided relative to traditional inpatient physicians. An electric search using Hospitalists [Title] OR (hospital-based physicians [Title] OR hospital medicine [Title]), was conducted to identify related articles published before May 2018 through PubMed, Medline databases. Article type limited as systematic review or meta-analysis. 17 studies were recruited. Editorials and conceptual articles were excluded. A total of 7 met criteria for inclusion. Comparative evaluations presenting quantitative data on outcome measures of care. Most of the extant research on this subject was conducted in the United States. The majority of review articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay and total hospital costs; however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern. Persistent issues include insufficient reporting of sample populations, and failure to adjust for established confounders. Our findings suggest that HP care in Taiwan has potential to improve efficiency in medical expenditure, length of stay without adversely affecting clinical outcome. However, the patient experiences and clinical outcome of HP care were not uniformly improved and further study were needed. Future studies should explore HP model structures that drive care outcome.

並列關鍵字

hospitalist ； inpatient care ； quality measure ； systematic review and meta-analysis