Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. 863-864 (doi:10.1542/peds.2006-3725)

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LETTER TO THE EDITOR

Evidence-Based Medicine Practice by Hospitalists and Community Pediatricians

Susumu Inoue, MD
Division of Hematology/Oncology
Department of Pediatrics
Hurley Medical Center
Flint, MI 48503
Department of Pediatrics/Human Development
Michigan State University College of Human Medicine
East Lansing, MI 48824-1317

To the Editor.—

The Pediatrics article "Variations in Management of Common Inpatient Pediatric Illnesses: Hospitalists and Community Pediatricians" by Conway et al¹ is both interesting and provocative. The results demonstrated that the hospitalists practiced significantly more evidenced-based medicine than community pediatricians. The results remained the same, according to the authors, even after controlling such variables as postresidency years, fellowship training, time spent attending, and practice in academic or nonacademic centers. This is surprising, because these variables are major factors that would impact on the type of practice.

In their article, the authors stated: "Hospitalists both specialize in inpatient pediatrics and attend a greater number of inpatients per year, and this suggests that this expertise leads to greater adherence to evidence-based therapies." This statement, however, was not supported by their findings. If this statement were true, then controlling such variables as years after residency, postgraduate training factor, time spent attending, and practice in an academic setting certainly would have erased the difference between the two in multivariate analysis. What, then, would make up this difference? There are several alternative and plausible explanations. One would be that hospitalists have a bigger incentive to practice evidence-based medicine. The incentive may be related to their increased responsibility in teaching students and residents as opposed to community pediatricians. An additional incentive may be a more closely monitored system in place to measure quality of care in the hospitals. The type of questions asked may be more related to strictly inpatient care than ambulatory care. It would be more informative if the authors included this type of information in their article. It is generally believed that the practice of evidence-based medicine is parallel to quality care. Therefore, the answer to the question of why hospitalists practice evidence-based medicine more often than community pediatricians is very important. The questionnaire used by these authors is quite creative, and I believe that it may yield quite informative data on the quality of care.

REFERENCE

1. Conway PH, Edwards S, Stucky ER, Chiang VW, Ottolini MC, Landrigan CP. Variations in management of common inpatient pediatric illnesses: hospitalists and community pediatricians. Pediatrics. 2006;118 :441 –447[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Inoue, S. Search for Related Content PubMed PubMed Citation Articles by Inoue, S. Related Collections Office Practice Social Bookmarking                         What's this?