Premium
Trends in inpatient continuity of care for a cohort of Medicare patients 1996–2006
Author(s) -
Fletcher Kathlyn E.,
Sharma Gulshan,
Zhang Dong,
Kuo YongFang,
Goodwin James S.
Publication year - 2011
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.916
Subject(s) - medicine , hospital medicine , cohort , copd , generalist and specialist species , retrospective cohort study , socioeconomic status , emergency medicine , inpatient care , family medicine , health care , population , environmental health , ecology , habitat , economics , biology , economic growth
BACKGROUND: Little is known about how changes in health care delivery, such as the use of hospitalists, have impacted inpatient continuity. OBJECTIVE: To examine the extent of inpatient discontinuity (ie, being seen by more than one generalist physician) during hospitalization for selected patients. DESIGN: Retrospective cohort. SETTING: 4,859 US hospitals. PATIENTS: Medicare fee‐for‐service beneficiaries hospitalized for chronic obstructive pulmonary disease (COPD), pneumonia, and congestive heart failure (CHF) from 1996 through 2006. MEASUREMENTS: We analyzed the proportion of Medicare beneficiaries who received care from 1, 2, or 3 or more generalist physicians during hospitalization. We also examined the factors associated with continuity during the hospitalization. RESULTS: Between 1996 and 2006, 64.3% of patients received care from 1, 26.9% from 2 and 8.8% from 3 or more generalist physicians during hospitalization. The percentage of patients who received care from one generalist physician declined from 70.7% in 1996 to 59.4% in 2006 ( P < 0.001). In a multivariable analysis, continuity with one generalist physician decreased by 5.5% (95% CI, 5.3%–5.6%) per year between 1996 and 2006. Patients receiving all care from hospitalists saw fewer generalist physicians compared to those who received all care from a non‐hospitalist or both. Older patients, females, non‐Hispanic whites, those with higher socioeconomic status, and those with more comorbidities were more likely to receive care from multiple generalist physicians. LIMITATIONS: The results may not be generalizable to non‐Medicare populations. CONCLUSIONS: Hospitalized patients are experiencing less continuity than 10 years ago. The hospitalist model of care does not appear to play a role in this discontinuity. Journal of Hospital Medicine 2011;6:441–447. © 2011 Society of Hospital Medicine.