Assessment of Care Handoffs Among Hospitalist Physicians and 30-Day Mortality in Hospitalized Medicare Beneficiaries

Farid, Monica; Tsugawa, Yusuke; Jena, Anupam B.

doi:10.1001/jamanetworkopen.2021.3040

Cited by 9 publications

(18 citation statements)

References 30 publications

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“…A 2021 cross-sectional study evaluated the impact of physician hand-off among Medicare patients admitted to hospital in the US. 5 The authors restricted their analysis to hospitalists who worked at least 7 consecutive days and compared 30-day postdischarge mortality of patients with different probabilities of hand-off based on date of patient admission relative to handover schedule. Similar to our study, they found no overall association between physician hand-offs and 30-day mortality, although an exploratory analysis suggested an increase in 30-day mortality for patients with more severe illness.…”

Section: Discussionmentioning

confidence: 99%

Association between physician continuity of care and patient outcomes in clinical teaching units: a cohort analysis

Ambasta

Omodon

Williamson

2023

cmajo

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T ransitions of patient care through hand-offs between health care teams are ubiquitous, particularly in hospitals. Hospitalists, usually internists, provide most of the general medical care to patients admitted to hospital. They typically work contiguous days, handing off patients at the end of their block, such that patients are likely to see more than 1 internist during their hospital admission. 1,2 Data on the association between breaks in continuity of care in hospitals and patient outcomes are limited. 3,4 A 2021 cross-sectional study that assessed care hand-offs among hospitalist physicians in the United States found no difference in postdischarge 30-day mortality. 5 However, an exploratory analysis within this study found that patients with higher illness severity had a higher 30-day mortality with increased physician hand-offs. A 2020 retrospective cohort study involving patients cared for by hospitalists in the top quartile of continuous schedules in Texas had significantly lower postdischarge mortality, readmission rates, costs and higher rates of discharge home than patients who were cared for by hospitalists with discontinuous schedules. 1 In Canada, the clinical teaching unit (CTU) is a teambased structure that delivers care to general medical patients in academic hospitals. 6 The attending physician serves as the most responsible physician for patient care, while simultaneously teaching learners of various skill levels and leading multidisciplinary teams of health care providers. 7 The attending physicians instruct and act as role models for the future physician workforce. 8 This role requires the execution of professional competence and is vulnerable to several unpredictable contextual factors. 9 Given the complexity of this role, an individual physician works a limited number of contiguous days to prevent burnout. 4 The prevalence of discontinuity of care by attending physicians on CTUs makes it important to understand its impact on patient outcomes. We aimed to evaluate the association between the number of Association between physician continuity of care and patient outcomes in clinical teaching units: a cohort analysis

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Section: Discussionmentioning

confidence: 99%

Association between physician continuity of care and patient outcomes in clinical teaching units: a cohort analysis

Ambasta

Omodon

Williamson

2023

cmajo

View full text Add to dashboard Cite

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“…Further, hospitalists are generalists and may have discontinuous schedules. While these aspects of their job structure may provide benefits, such as reduced complications, LOS, and readmissions, they may also serve to fragment care or introduce more complexity for patients seeking answers to subspecialty specific questions, which could result in lower scores related to perceptions of communication and responsiveness in the Patient Experience domain 33–35 . These aspects of their work structure may further contribute to worse Patient Experience of care scores.…”

Section: Discussionmentioning

confidence: 99%

“…While these aspects of their job structure may provide benefits, such as reduced complications, LOS, and readmissions, they may also serve to fragment care or introduce more complexity for patients seeking answers to subspecialty specific questions, which could result in lower scores related to perceptions of communication and responsiveness in the Patient Experience domain. [33][34][35] These aspects of their work structure may further contribute to worse Patient Experience of care scores. The current work supports that idea as while there is a positive association between an increased hospitalist ratio and the Patient Experience domain, the 95% CI is relatively broad (0.20-4.77) and demonstrates a significance level of only less than .05.…”

Section: Discussionmentioning

confidence: 99%

The Hospital Value‐Based Purchasing Program: Do hospitalists improve health care value

Spaulding

Tafili

Dunn

et al. 2022

Journal of Hospital Medicine

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Introduction As healthcare organizations examine the associated benefits of employing a larger hospitalist workforce, there is a need to better understand the association with patients' quality, experience, and efficiency. However, there is a lack of information regarding how hospital use of hospitalists over time influences hospital scoring on quality programs, such as the Center for Medicare and Medicaid Services (CMS) Hospital Inpatient Value‐Based Purchasing (HVBP) Program. This study examines the association between hospitalist staffing between 2014 and 2019 and HVBP scores. Methods We used a cross‐sectional panel study design. Total Performance Score (TPS) and its domains were obtained from CMS from 2014 to 2019 and merged with the American Hospital Association Annual Survey Database. We utilized random‐effects multivariable panel regression models and zero‐inflated negative binomial regression to examine the association between the hospitalist‐staffing ratio and the HVBP Program. All models were adjusted for hospital characteristics. Results A total of 2126 hospitals were included in the study. The average ratio of hospitalists per staffed bed was 0.06, with a standard deviation of 0.15. This study suggests that hospitals that employ a higher percentage of hospitalists see improvement in their overall TPS (β = 5.40; p < .001), Patient Experience (β = 2.49; p <.05), and Efficiency (incidence‐rate ratio= 1.41; p < .001) domain. However, the Clinical Care domain was no different in organizations employing more hospitalists. Conclusion There are benefits associated with TPS, Patient Experience, and Efficiency from employing hospitalists. Managers should seek opportunities to leverage hospitalists' expertise in providing care, particularly in improving care processes.

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“…It may also be that efforts to improve the handoff of patients between physician shifts have led to a better quality of care by physicians taking care of patients over the weekend and, thus, fewer preventable adverse events. However, a recent study published in 2021 by Farid et al [ 26 ] showed that physician handoff was only associated with slightly greater mortality among patients with high illness severity. Nonetheless, there is a paucity of contemporary data regarding physician handoff and preventable adverse events.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Admission During the Weekend On In-Hospital Outcomes for Patients With Peripartum Cardiomyopathy

López¹,

Duarte²,

Rullan³

et al. 2022

Cureus

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BackgroundPrevious studies have shown that patients with heart failure (HF) and cardiogenic shock (CS) have worse outcomes when admitted over the weekend. Since peripartum cardiomyopathy (PPCM) is a cause of CS and persisting HF, it is reasonable to extrapolate that admission over the weekend would also have deleterious effects on PPCM outcomes. However, the impact of weekend admission has not been specifically evaluated in patients with PPCM. MethodsWe analyzed the National Inpatient Sample (NIS) from 2016 to 2019. The International Classification of Diseases, tenth revision (ICD-10) codes were used to identify all admissions with a primary diagnosis of PPCM. The sample was divided into weekday and weekend groups. We performed a multivariate regression analysis to estimate the effect of weekend admission on specified outcomes. ResultsA total of 6,120 admissions met the selection criteria, and 25.3% (n=1,550) were admitted over the weekend. The mean age was 31.3 ± 6.4 years. There were no significant differences in baseline characteristics between study groups. After multivariate analysis, weekend admission for PPCM was not associated with in-hospital mortality, ventricular arrhythmias, sudden cardiac arrest, thromboembolic events, cardiovascular implantable electronic device placement, and mechanical circulatory support insertion. ConclusionIn conclusion, although HF and CS have been associated with worse outcomes when admitted over the weekend, we did not find weekend admission for PPCM to be independently associated with worse clinical outcomes after multivariate analysis. These findings could reflect improvement in the coordination of care over the weekend, improvement in physician handoff, and increased utilization of shock teams.

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Assessment of Care Handoffs Among Hospitalist Physicians and 30-Day Mortality in Hospitalized Medicare Beneficiaries

Cited by 9 publications

References 30 publications

Association between physician continuity of care and patient outcomes in clinical teaching units: a cohort analysis

Association between physician continuity of care and patient outcomes in clinical teaching units: a cohort analysis

The Hospital Value‐Based Purchasing Program: Do hospitalists improve health care value

The Effect of Admission During the Weekend On In-Hospital Outcomes for Patients With Peripartum Cardiomyopathy

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