Family Medicine Patients Have Shorter Length of Stay When Cared for on a Family Medicine Inpatient Service

Background While socioeconomic status has been linked to hospital readmissions for several conditions, reliable measures of individual socioeconomic status are often not available. HOUSES, a new measure of individual socioeconomic status based upon objective public data about one's housing unit, is inversely associated with overall hospitalization rate but it has not been studied with respect to readmissions. Purpose To determine if patients in the lowest HOUSES quartile are more likely to be readmitted within 30 days (short-term) and 180 days (long-term). Methods A retrospective cohort study of 11 993 patients having 21 633 admissions was conducted using generalized linear mixed-effects models. Results HOUSES quartile did not show any significant association with early readmission. However, when compared to the lowest HOUSES quartile, the second quartile (OR = 0.90, 95%CI 0.83-0.98) and the third quartile (OR = 0.91, 95%CI 0.83-0.99) were associated with lower odds of late readmission while the highest quartile (OR = 0.91, 95%CI 0.82-1.01) was not statistically different. Conclusion HOUSES was associated with late readmission, but not early readmission. This may be because early readmissions are influenced by medical conditions and hospital care while late readmissions are influenced by ambulatory care and home-based factors. Since HOUSES relies on public county assessor data, it is generally available and may be used to focus interventions on those at highest risk for late readmission.

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“…In our experience, these patients rarely seek care outside our institution due to continuity and insurance reasons. 8 , 29 , 58 …”

Section: Discussionmentioning

confidence: 99%

Association of Early and Late Hospital Readmissions with a Novel Housing-Based Socioeconomic Measure

Zurek

Boswell

Miller

et al. 2022

Health Services Research and Managerial Epidemiology

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“…24Family medicine patients have shorter length of stay when cared for on a family medicine inpatient service(39) United States Test the hypothesis that local family medicine patients admitted to a family medicine inpatient service have shorter length of stay than those admitted to general hospitalist services which also care for tertiary patients at an academic medical centre.25 Does doctor-patient communication affect patient satisfaction with hospital care? Results of an analysis with a novel instrumental variable (40) United States Determine the relationship between physicians' communication behaviours and patients' overall satisfaction with hospital care using a novel instrumental variable to address possible confounding of this association by patient attributes.…”

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Performance management of generalist care for hospitalised multimorbid patients—a scoping review for value-based care

Khoo,

Lim,

Lai

2024

Front. Health Serv.

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ObjectivesGiven the shift towards value-based healthcare and the increasing recognition of generalist care, enacting value-based healthcare for generalist care is critical. This work aims to shed light on how to conduct performance management of generalist care to facilitate value-based care, with a focus on medical care of hospitalised patients.Design and settingA scoping review of published literature was conducted. 30 publications which were relevant to performance management of generalist medical inpatient care were included in the review.Outcome measuresThe performance measures used across the studies were analysed and other qualitative findings were also obtained.ResultsWe report an overall lack of research on performance management methods for generalist inpatient care. Relevant performance measures found include both outcome and process of care measures and both clinical and reported measures, with clinical outcome measures the most frequently reported. Length of stay, readmission rates and mortality were the most frequently reported. The insights from the papers emphasise the relevance of process of care measures for performance management, the advantages and disadvantages of types of measures and provide suggestions relevant for performance management of generalist inpatient care.ConclusionThe findings of this scoping review outline a variety of performance measures valuable for generalist inpatient care including clinical outcome measures, reported outcome measures and process of care measures. The findings also suggest directions for implementation of such performance management, including emphasis on physician level performance management and the importance of documentation training. Further research for selecting and operationalising the measures for specific contexts and developing a comprehensive performance management system involving these measures will be important for achieving value-based healthcare for generalist inpatient care.

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A quantitative analysis of the effect of continuity of care on 30-day readmission and in-hospital mortality among patients with acute ischemic stroke

Okere

Sanogo

Balkrishnan

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Family Medicine Patients Have Shorter Length of Stay When Cared for on a Family Medicine Inpatient Service

Cited by 4 publications

References 31 publications

Association of Early and Late Hospital Readmissions with a Novel Housing-Based Socioeconomic Measure

Association of Early and Late Hospital Readmissions with a Novel Housing-Based Socioeconomic Measure

Performance management of generalist care for hospitalised multimorbid patients—a scoping review for value-based care

A quantitative analysis of the effect of continuity of care on 30-day readmission and in-hospital mortality among patients with acute ischemic stroke

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