Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists,JAMA Internal Medicine

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Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists
JAMA Internal Medicine ( IF 22.5 ) Pub Date : 2017-12-01 , DOI: 10.1001/jamainternmed.2017.5824
Jennifer P. Stevens ₁ , David J. Nyweide ₂ , Sha Maresh ₂ , Laura A. Hatfield ₃ , Michael D. Howell ₄ , Bruce E. Landon ₅

Affiliation

Importance A physician’s prior experience caring for a patient may be associated with patient outcomes and care patterns during and after hospitalization. Objective To examine differences in the use of health care resources and outcomes among hospitalized patients cared for by hospitalists, their own primary care physicians (PCPs), or other generalists. Design, Setting, and participants This retrospective study analyzed admissions for the 20 most common medical diagnoses among elderly fee-for-service Medicare patients from January 1 through December 31, 2013. Patients had at least 1 previous encounter with an outpatient clinician within the 365 days before admission, and diagnoses were restricted to the 20 most common diagnosis related groups. Data were collected from Medicare Parts A and B claims data, and outcomes were analyzed from January 1, 2013, through January 31, 2014. Exposures Physician types included hospitalists, PCPs (ie, the physicians who provided a plurality of ambulatory visits in the year preceding admission), or generalists (not the patients’ PCPs). Main Outcomes and Measures Number of in-hospital specialist consultations, length of stay, discharge site, all-cause 7- and 30-day readmission rates, and 30-day mortality. Results A total of 560 651 admissions were analyzed (41.9% men and 59.1% women; mean [SD] age, 80 [8] years). Patients’ physicians were hospitalists in 59.7% of admissions; PCPs, in 14.2%; and other generalists, in 26.1%. Primary care physicians used consultations 3% more (relative risk, 1.03; 95% CI, 1.02-1.05) and other generalists used consultations 6% more (relative risk, 1.06; 95% CI, 1.05-1.07) than hospitalists. Lengths of stay were 12% longer among patients cared for by PCPs (adjusted incidence rate ratio, 1.12; 95% CI, 1.11-1.13) and 6% longer among those cared for by other generalists (adjusted incidence rate ratio, 1.06; 95% CI, 1.05-1.07) compared with patients cared for by hospitalists. However, PCPs were more likely to discharge patients home (adjusted odds ratio [AOR], 1.14; 95% CI, 1.11-1.17), whereas other generalists were less likely to do so (AOR, 0.94; 95% CI, 0.92-0.96). Relative to hospitalists, patients cared for by PCPs had similar readmission rates at 7 days (AOR, 0.98; 95% CI, 0.96-1.01) and 30 days (AOR, 1.02; 95% CI, 0.99-1.04), whereas other generalists’ readmission rates were greater than hospitalists’ rates at 7 (AOR, 1.05; 95% CI, 1.02-1.07) and 30 (AOR, 1.04; 95% CI, 1.03-1.06) days. Patients cared for by PCPs had lower 30-day mortality than patients of hospitalists (AOR, 0.94; 95% CI, 0.91-0.97), whereas the mortality rate of patients of other generalists was higher (AOR, 1.09; 95% CI, 1.07-1.12). Conclusions and Relevance A PCP’s prior experience with a patient may be associated with inpatient use of resources and patient outcomes. Patients cared for by their own PCP had slightly longer lengths of stay and were more likely to be discharged home but also were less likely to die within 30 days compared with those cared for by hospitalists or other generalists.

中文翻译：

住院医师、初级保健医师和其他全科医生之间医院资源使用和结果的比较

重要性医生之前照顾病人的经验可能与住院期间和住院后的病人结果和护理模式有关。目的检查由住院医师、他们自己的初级保健医生 (PCP) 或其他全科医生护理的住院患者在使用卫生保健资源和结果方面的差异。设计、设置和参与者这项回顾性研究分析了 2013 年 1 月 1 日至 12 月 31 日期间按服务收费的老年医疗保险患者中 20 种最常见医疗诊断的入院情况。患者之前至少与 365入院前几天，并且诊断仅限于 20 个最常见的诊断相关组。数据来自医疗保险 A 部分和 B 部分索赔数据，并从 1 月 1 日开始分析结果，2013 年，至 2014 年 1 月 31 日。暴露医师类型包括住院医师、PCP（即在入院前一年提供多次门诊就诊的医师）或全科医生（不是患者的 PCP）。主要结果和措施住院专家咨询次数、住院时间、出院地点、7 天和 30 天全因再入院率以及 30 天死亡率。结果共分析了 560 651 名入院患者（41.9% 男性和 59.1% 女性；平均 [SD] 年龄，80 [8] 岁）。在 59.7% 的入院病例中，患者的医生是住院医师；PCP，14.2%；和其他通才，占 26.1%。初级保健医生使用咨询的次数比住院医师多 3%（相对风险，1.03；95% CI，1.02-1.05），其他全科医生使用咨询次数多 6%（相对风险，1.06；95% CI，1.05-1.07）。由 PCP 护理的患者的住院时间延长了 12%（调整后的发病率比，1.12；95% CI，1.11-1.13），而由其他全科医生护理的患者的住院时间延长了 6%（调整后的发病率比，1.06；95% CI，1.05-1.07）与住院医师护理的患者相比。然而，PCP 更有可能让患者出院回家（调整后的优势比 [AOR]，1.14；95% CI，1.11-1.17），而其他通才这样做的可能性较小（AOR，0.94；95% CI，0.92-0.96 ）。相对于住院医师，由 PCP 治疗的患者在 7 天（AOR，0.98；95% CI，0.96-1.01）和 30 天（AOR，1.02；95% CI，0.99-1.04）时的再入院率相似，而其他全科医生的再入院率在 7 (AOR, 1.05; 95% CI, 1.02-1.07) 和 30 (AOR, 1.04; 95% CI, 1.03-1.06) 天时高于住院医师。由 PCP 治疗的患者的 30 天死亡率低于住院患者（AOR，0.94；95% CI，0.91-0.97），而其他全科医生患者的死亡率更高（AOR，1.09；95% CI，1.07） -1.12）。结论和相关性 PCP 先前治疗患者的经验可能与住院患者对资源的使用和患者结局有关。与由住院医师或其他全科医生护理的患者相比，由自己的 PCP 护理的患者住院时间略长，更有可能出院回家，但在 30 天内死亡的可能性也更低。结论和相关性 PCP 先前治疗患者的经验可能与住院患者对资源的使用和患者结局有关。与由住院医师或其他全科医生护理的患者相比，由自己的 PCP 护理的患者住院时间略长，更有可能出院回家，但在 30 天内死亡的可能性也更低。结论和相关性 PCP 先前治疗患者的经验可能与住院患者对资源的使用和患者结局有关。与由住院医师或其他全科医生护理的患者相比，由自己的 PCP 护理的患者住院时间略长，更有可能出院回家，但在 30 天内死亡的可能性也更低。

更新日期：2017-12-01

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