SHM Converge Scientific Abstract ePoster Gallery-A Novel Model for Attributing Quality Metrics in Hospitalist Care

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This study proposes a new model for attributing hospital quality metrics, such as length of stay (LOS) and readmission, to individual hospitalists. The motivation is that traditional models assign these outcomes to the discharging provider, even though that provider may have had limited influence during long hospitalizations. The authors aimed to create a fairer attribution system that better reflects true provider impact.<br /><br />Using three years of data from five Intermountain Health hospitals, they analyzed 51,610 inpatient encounters, 231,146 inpatient days, 88 hospitalists, and 120 hospitalist-hospital pairs. Under the new model, a hospitalist is assigned LOS and readmission only if they oversee at least 30% of the inpatient stay and are also the discharging provider. All encounters still retain hospital-level group attribution.<br /><br />Key findings:<br />- 11.8% of encounters would no longer be attributed to any individual hospitalist.<br />- Encounters still attributed to a hospitalist had shorter stays, with median LOS of 2.9 days, compared with 6.8 days for encounters no longer attributed to an individual provider.<br />- Patients with attributed encounters spent a median of 2 days under the discharging hospitalist, versus only 1 day in the non-attributed group.<br />- Readmission and mortality were lower in the attributed group (7-day readmission 6.1% vs. 9.0%; 7-day mortality 2.3% vs. 4.2%).<br />- The novel model improved identification of outlier hospitalists, showing more extreme LOS Z-scores than the standard model.<br /><br />Overall, the authors conclude that this model better aligns accountability with actual influence, especially for longer hospital stays, and may improve fairness in compensation and quality measurement.

Asset Subtitle

Harris L. Carmichael

Meta Tag

Author List Harris L. Carmichael, Michael Pirozzi, Monique Mahlum, Rajendu Srivastava, Richard Patten

Category Research

Concept Hospitalist Quality Metric Attribution

Concept Length of Stay

Concept Readmission

Concept Discharging Provider

Concept Novel Attribution Model

Distinguished Finalist

Presenter Organization Intermountain Healthcare

Presenting Author Harris L. Carmichael

Track Quality Improvement

Keywords

hospital quality metrics

hospitalist attribution

length of stay

readmission

provider accountability

discharging provider

inpatient encounters

quality measurement

hospitalist performance

outlier identification

Hospitalist Quality Metric Attribution

Length of Stay

Readmission

Discharging Provider

Novel Attribution Model