All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Larry R Hearld

Nir Menachemi

Michael A Morrisey

Stephen J O'Connor

Bisakha Sen

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Two decades ago, a group of hospital-based physicians (hospitalists) specializing in the practice of hospital medicine were introduced in the U.S. health care system. Since then, this group of physicians has experienced an unprecedented growth. Prior studies on hospitalists have focused on benefits associated with the use of hospitalists. Compared to non-hospitalists, these studies revealed that hospitalists are more efficient as they are able to reduce length of stay and costs while achieving similar or better quality of care. However, most of these studies have been cross-sectional, limited to few hospitals, and limited to pediatric and teaching hospitals. Very little is known about the organizational and market characteristics associated with hospitals' use of hospitalists. Furthermore, to our knowledge, no studies were found in the literature which have explored the association between hospitals' use of hospitalists and organizational financial performance measured by revenues, costs, and operating margin and clinical performance such as readmission rates using a national sample of acute care hospitals. This longitudinal study (2007-2010) using a national sample of medical/surgical acute care hospitals operating in the U.S. explored these relationships. We found that large, urban, system-affiliated hospitals located in higher competition markets have a higher probability of using hospitalists. In addition, we found that an increase in the low proportion of full-time equivalent (FTE) hospitalists was associated with both lower costs and revenues. We also found that an increase in both the use of hospitalists as well as in the use of contracted hospitalists was associated with lower costs, but this was only marginally significant (p < 0.10). Finally, we found that an increase in the use of hospitalists, FTE hospitalists, high proportion of FTE hospitalists, and contracted hospitalists were associated with lower pneumonia readmissions, however, these associations were only marginally significant (p < 0.10).



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