SHM Converge Scientific Abstract ePoster Gallery-Handoff and Equity: Impact of Hospitalist Fragmentation on Racial Health Disparities

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This retrospective cohort study examined whether a fragmented hospitalist staffing model increased handoffs and potentially worsened racial inequities in care. At the institution’s Hospital Medicine service, general medicine patients are sometimes reassigned to “Jeopardy” providers when staff are unavailable or patient volume exceeds safe capacity. The concern was that this system, while maintaining coverage, may increase discontinuity of care and disproportionately affect general medicine patients, who are more likely to be Black and other minority patients.<br /><br />The study reviewed all encounters with at least one Hospital Medicine note from April 2018 to June 2019, using EHR data and scheduling records. Researchers analyzed patient demographics, length of stay, number of unique note authors, number of unique providers, and whether the patient was cared for by a Jeopardy provider or advanced practice provider.<br /><br />A total of 4,520 encounters were identified: 574 involved Jeopardy care and 3,946 did not. General medicine patients were more likely to be Black than patients on specialty services. Among all hospital medicine patients, those seen by Jeopardy providers had more unique authors and more fragmented care, despite a shorter average stay. In the general medicine subgroup, Jeopardy care was associated with trends toward longer length of stay and significantly more providers and care teams involved.<br /><br />The findings suggest that the current staffing model increases handoffs and fragmentation for general medicine patients, who already represent a more racially diverse and potentially vulnerable population. The authors argue that this may unintentionally amplify existing health disparities. In response, two new general medicine teams were added to reduce reliance on Jeopardy overflow coverage. The study recommends further research on whether this model affects adverse events, mortality, readmissions, and costs, especially among minority patients.

Asset Subtitle

Ellis Green

Meta Tag

Author List Ellis Green, Ethan Molitch-HoU, Grace LaShore, Khanh T. Nguyen, Matthew Cerasale

Category Research

Concept Staffing Model

Concept Handoff

Concept Fragmentation of Care

Concept Jeopardy Coverage

Concept Transitional Care

Distinguished Non-Finalist

Presenter Organization University of Chicago Medicine

Presenting Author Ellis Green

Track Quality Improvement

Keywords

retrospective cohort study

hospitalist staffing model

care fragmentation

patient handoffs

racial inequities

general medicine patients

Jeopardy providers

health disparities

hospital medicine

length of stay

Staffing Model

Handoff

Fragmentation of Care

Jeopardy Coverage

Transitional Care