Association of Hospitalist Care and Outcomes for Patients Electively Admitted for Chemotherapy

Abstract

Introduction: Patients with hematologic malignancies frequently receive elective anticancer therapy as inpatients. The impact of introducing hospitalists on quality outcomes in this subset of patients is unknown. Methods: Patients with leukemia or lymphoma electively admitted for anticancer therapy to either a hematologist-led service (TS; n=59) or to a hospitalist-led service (HS; n=102) during two parallel 18-month time periods were included. Mixed linear regression models with first-order random effects for intercept (individual) and slope (time) were used to estimate the association between service and the quality outcomes of length of stay (LOS), time from admission to anticancer therapy initiation, and discharge time of day. Results: For patients who received a fixed-duration anticancer therapy regimen, after adjustment for clinical and demographic covariates, mean LOS was reduced by >2 days (TS=5.97 days (95% CI: 5.13, 6.81); HS=3.88 days (95% CI, 3.53, 4.23); p<0.001), mean time from admission to first anticancer therapy administration decreased by 4 hours (TS=8.32 hours (95% CI: 5.72, 10.93); HS= 4.36 hours (95% CI: 3.49, 5.23); p=0.001)), and mean discharge time was similarly decreased by 110 minutes (TS=3:12 PM (95% CI: 2:06 PM, 4:19 PM); HS=1:22 PM (95% CI: 12:48 PM, 1:57 PM); p=0.01)). For regimens that required variable monitoring for post-treatment methotrexate clearance, tumor lysis syndrome, or white blood cell count recovery, no significant difference in outcomes was noted. Conclusion: Hospitalist care of patients with hematologic malignancies admitted for elective anticancer therapy may lead to improved quality and efficiency of care.