SHM Converge Scientific Abstract ePoster Gallery-Predictors of Provider-Level Variation in Hospital Medicine

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This study examined provider-level variation among hospitalists at an urban academic hospital using dashboard data from July 2020 to June 2021. Hospitalists who worked at least 20 days were grouped into quartiles based on performance in three metrics: individualized length of stay (LOS), glucose control, and diagnostic spending. The analysis used multivariate logistic regression adjusted for case-mix index.<br /><br />The results showed clear differences between the highest-performing quartile (Q1) and lowest-performing quartile (Q4). For LOS, more years since residency were associated with better performance: each additional year after residency was linked to about 10% lower odds of being in the lowest quartile, though this finding was borderline significant. For glucose control, greater engagement with the performance dashboard was associated with better outcomes; each additional dashboard login corresponded to about 35% lower odds of being in Q4 versus Q1, also borderline significant. For diagnostic spending, spending 50% of workdays on the direct-care hospitalist service was associated with a 95% lower odds of being in the lowest quartile, and this result was statistically significant.<br /><br />Overall, the study found statistically and clinically meaningful variation between top and bottom performers across all three quality measures. The findings suggest that provider experience, dashboard engagement, and service exposure may influence performance, and they point to potential targets for quality improvement. In particular, the association between dashboard use and glucose control suggests that self-monitoring may help improve care outcomes.

Asset Subtitle

Zachary A. Brown

Meta Tag

Author List Bradley A. Sharpe, Logan Pierce, Maggie Jones, Ping Hua Chen, Priya A. Prasad, Sajan Patel, Sandra Oreper, Zachary A. Brown

Category Research

Concept Hospital Medicine

Concept Provider Clinical Practice Variability

Concept Quality Improvement

Concept Quality Metric

Concept Length of Stay

Distinguished Non-Finalist

Presenter Organization UCSF Department of Hospital Medicine

Presenting Author Zachary A. Brown

Track Quality Improvement

Keywords

hospitalists

provider-level variation

length of stay

glucose control

diagnostic spending

dashboard engagement

quality improvement

multivariate logistic regression

case-mix index

urban academic hospital

Hospital Medicine

Provider Clinical Practice Variability

Quality Improvement

Quality Metric

Length of Stay