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.KEY WORDS: continuity of care; health care costs; health services research; hospital medicine.

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The purpose of this project was to survey rural, minority, and underserved Alabamians regarding their perceptions of COVID-19 information, testing, and vaccination. Community health workers surveyed 3721 individuals from October 20-December 31, 2020. Participants came from 46 of Alabama's 67 counties (35 rural and 11 urban counties) and were largely Black (69.6%), female (56.5%), and between the ages of 40-59 years (34.8%). The majority of respondents reported that recommendations from public health agencies were easy to understand, information on COVID-19 was easy to find, and they felt confident in keeping themselves safe from infection. Most also reported they would get tested for COVID-19 if they had been exposed to someone who tested positive. Hesitancy to receive a COVID-19 vaccine was very high among all respondents; only 38.7% said they would be vaccinated. Significant differences by sex, race/ethnicity, age, and/or rural/urban status were seen for all survey items. Findings from this survey differ from other published studies and will be of interest to states with large rural, underserved, and minority populations as they tailor messaging for those most vulnerable. Findings also are now validated by Alabama's poor response to vaccine administration, which falls far short of the national vaccination rate, putting Alabamians at even greater risk. Building vaccine confidence among low vaccine populations remains challenging yet is imperative, especially for those populations with preexisting economic, social, and physical conditions that place them at continued high risk for COVID-19 infection.

BACKGROUND: Patient-physician continuity is difficult to achieve in hospital settings because of the need to provide care continuously. The impact of hospital physician discontinuity on patient safety is unknown.

Residents' self-reported and actual use of CBCs and chemistry panels is significantly higher than that of hospitalists in the same hospital. Our results reveal an opportunity for greater supervision and improved instruction of cost-conscious ordering practices.