The Hospitalist-led Model of Oncology Inpatients in an Academic Health System: Perspectives of Hospitalists and Oncologists

Author(s): Tanya Roxanne Clarke, Maria Hendrika van Zuilen

Objectives: The purpose of this study was to compare the perspectives of Hospitalists and Oncologists on Hospitalist-led inpatient oncology care.

Methodology: We developed two related surveys, one for Oncologists and one for Hospitalists. These surveys focused on perspectives, communication, and coordination of care. All Hospitalists and Oncologists in our academic health system were invited to participate in this study.

Results: A joint total of fifty-two hospitalists and oncologists completed the survey. Oncologists and hospitalists generally agreed that solid tumor patients should be admitted to an oncologist-led service and that the oncologist should lead the discussion of cancer-related concerns, although there appeared to be a misalignment with what happens in practice. Hospitalists indicated that most of the solid tumor patients admitted to their service were “end-of-life" and should have been in palliative/hospice care, while most oncologists reported that they only “occasionally” transitioned these patients to hospice in the in-patient setting. Overall, only 37% of hospitalists rated their overall experience of taking care of solid tumor patients as positive. Ratings indicated they wanted more input from the oncologists.

Discussion: The hospitalist-led model for managing solid tumor inpatients has been adapted in many cancer institutions across the United States. This study revealed that there is room for improved coordination of care and communication between hospitalists and oncologists, especially with end-of-life care. It would be very insightful to have both oncologist and hospitalist-led services and compare metrics for length of stay, mortality, readmission rates, transition to hospice care and physician and patient satisfaction.