Srivastava Rajendu, Norlin Chuck, James Brent C, Muret-Wagstaff Sharon, Young Paul C, Auerbach Andrew
Division of General Pediatrics, University of Utah, 100 North Medical Dr, MAPS, Salt Lake City, UT 84113, USA.
Pediatrics. 2005 Jan;115(1):34-8. doi: 10.1542/peds.2004-0855.
Pediatric hospitalist systems are being implemented widely. Their implementation may be influenced by physician attitudes, which may vary according to practice type (eg, community or hospital-based practice) and personal characteristics (eg, age and practice location). Little evidence exists to describe factors relevant to pediatric systems. The objective of this study was to determine physicians' attitudes regarding hospitalists and associated physician and practice characteristics.
We used a cross-sectional survey of all physicians with admitting privileges at a tertiary-care, pediatric, teaching hospital in the Intermountain West in April 2002. Outcomes included survey responses indicating attitudes toward the effects of the hospitalist system on quality of care, patient satisfaction, and teaching.
A total of 313 of 368 physicians (85%) responded, 191 of whom (61%) were community physicians; 224 respondents (72%) spent the majority of their time in outpatient care. Community physicians more often characterized inpatient care as an inefficient use of time (45% vs 25%) but were less likely to think that hospitalists would improve the quality of care (49% vs 68%) or increase patient satisfaction (10% vs 30%). In multivariate models examining predictors of overall attitudes toward hospitalists, being a community physician (6.4 points more negative) and admitting patients at >1 hospital (3.3 points more negative) were associated with less favorable attitudes. Being <40 years of age (4.5 points more positive) and practicing >13 miles from the hospital (4.3 points more positive) were associated with more positive attitudes.
Attitudes regarding hospitalist systems differ between physician groups and are influenced by practice characteristics. Understanding these differences and tailoring hospitalist systems to address them will be important as pediatric hospitalist systems are implemented nationwide.
儿科住院医师制度正在广泛推行。其推行可能受到医师态度的影响，而医师态度可能因执业类型（如社区或医院执业）和个人特征（如年龄和执业地点）而异。目前几乎没有证据描述与儿科住院医师制度相关的因素。本研究的目的是确定医师对住院医师以及相关医师和执业特征的态度。
我们于2002年4月对美国西部山间地区一家三级儿科教学医院所有具有收治权限的医师进行了横断面调查。调查结果包括表明对住院医师制度对医疗质量、患者满意度和教学影响的态度的调查回复。
368名医师中有313名（85%）回复，其中191名（61%）为社区医师；224名回复者（72%）大部分时间从事门诊医疗工作。社区医师更常认为住院治疗是对时间的低效利用（45%对25%），但不太可能认为住院医师会提高医疗质量（49%对68%）或提高患者满意度（10%对30%）。在多变量模型中，考察对住院医师总体态度的预测因素，社区医师（负面程度高6.4分）和在多家医院收治患者（负面程度高3.3分）与不太有利的态度相关。年龄小于40岁（正面程度高4.5分）和执业地点距离医院超过13英里（正面程度高4.3分）与更积极的态度相关。
不同医师群体对住院医师制度的态度存在差异，并受到执业特征的影响。随着儿科住院医师制度在全国范围内推行，了解这些差异并调整住院医师制度以应对这些差异将很重要。
