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J Gen Intern Med. 2014 Jul;29(7):1004-8. doi: 10.1007/s11606-013-2754-0. Epub 2014 Jan 17.

The impact of hospitalist discontinuity on hospital cost, readmissions, and patient satisfaction.

Author information

1
Systems Engineering, University Health Care System, 1350 Walton Way, Augusta, GA, 30901, USA, jonathan.turner.work@gmail.com.

Abstract

BACKGROUND:

Achieving patient-physician continuity is difficult in the inpatient setting, where care must be provided continuously. Little is known about the impact of hospital physician discontinuity on outcomes.

OBJECTIVE:

To determine the association between hospital physician continuity and percentage change in median cost of hospitalization, 30-day readmission, and patient satisfaction with physician communication.

DESIGN:

Retrospective observational study using various multivariable models to adjust for patient characteristics.

PARTICIPANTS:

Patients admitted to a non-teaching hospitalist service in a large, academic, urban hospital between 6 July 2008 and 31 December 2011.

MAIN MEASURES:

We used two measures of continuity: the Number of Physicians Index (NPI), and the Usual Provider of Continuity (UPC) index. The NPI is the total number of unique physicians caring for a patient, while the UPC is calculated as the largest number of patient encounters with a single physician, divided by the total number of encounters. Outcome measures were percentage change in median cost of hospitalization, 30-day readmissions, and top box responses to satisfaction with physician communication.

KEY RESULTS:

Our analyses included data from 18,375 hospitalizations. Lower continuity was associated with modest increases in costs (range 0.9-12.6 % of median), with three of the four models used achieving statistical significance. Lower continuity was associated with lower odds of readmission (OR = 0.95-0.98 across models), although only one of the models achieved statistical significance. Satisfaction with physician communication was lower, with less continuity across all models, but results were not statistically significant.

CONCLUSIONS:

Hospital physician discontinuity appears to be associated with modestly increased hospital costs. Hospital physicians may revise plans as they take over patient care responsibility from their colleagues.

PMID:
24435485
PMCID:
PMC4061363
DOI:
10.1007/s11606-013-2754-0
[Indexed for MEDLINE]
Free PMC Article

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