Inpatient Management by Hospitalists versus Community Pediatricians

These authors, from multiple institutions, conducted a national survey to compare the self-reported use among hospitalists and office-based pediatricians of 48 diagnostic and treatment modalities for common inpatient conditions. A total of 198 pediatric hospitalists and 228 randomly selected community pediatricians met inclusion criteria. Survey response rates for hospitalists and community pediatricians were 67% and 15%, respectively. For management of children with urinary tract infections, asthma, bronchiolitis, or gastroenteritis, a total of 12 diagnostic or treatment choices were determined to represent appropriate care based on standards published in BMJ Clinical Evidence or AAP Practice Guidelines. Multivariate regression was performed to assess differences between hospitalists and office-based pediatricians after controlling for the effect of confounding variables including practice in an academic setting and volume of inpatient care.

Analysis of survey results found that hospitalists were significantly more likely than office-based pediatricians to report “often” or “almost always” following evidence-based guidelines for using inhaled albuterol, systemic steroids, and inhaled ipratroprium in the first 24 hours for asthma, and for obtaining voiding cystrourethrogram and renal ultrasound for children with a first urinary tract infection. Hospitalists …