The impact of fragmentation of hospitalist care on length of stay

“…Epstein et al also reported that decreased continuity of care was associated with longer hospital length of stay. 6 Though provocative, the study is limited in that continuity and length of stay are interrelated. As a patient's length of stay increases, so does the likelihood of discontinuity.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Hospitalist Discontinuity on Hospital Cost, Readmissions, and Patient Satisfaction

Turner

Hansen²,

Hinami³

et al. 2014

J GEN INTERN MED

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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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“…In the context of US hospital medicine practice, this fragmentation may compromise safety or throughput; however, no such deficit has been detected to date in the context of acute medicine practice in the UK. 13 Mismatch between AMU bed or staff capacity and the number or rate of hospital admissions can generate safety risks or give away efficiency gains. Further inefficiencies can develop if hospital-wide processes of handover, medical decision making, patient transport, and discharge are not synchronized with AMU outflow and intake.…”

Section: Weaknesses and Strengths Of Acute Medicine Model Applicable mentioning

confidence: 99%

Acute medicine in the United Kingdom: First‐hand perspectives on a parallel evolution of inpatient medical care

Smith

Stein

Jones

2012

Journal of Hospital Medicine

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The impact of fragmentation of hospitalist care on length of stay

Abstract: Disclosure: Data collection, analysis, and author salaries were all paid for by IPC-The Hospitalist Company.BACKGROUND: Different hospitalist staffing models provide different levels of inpatient continuity of care, which may impact

Cited by 58 publications

References 11 publications

Hospitalist‐led medicine emergency department team: Associations with throughput, timeliness of patient care, and satisfaction

Hospitalist‐led medicine emergency department team: Associations with throughput, timeliness of patient care, and satisfaction

The Impact of Hospitalist Discontinuity on Hospital Cost, Readmissions, and Patient Satisfaction

Acute medicine in the United Kingdom: First‐hand perspectives on a parallel evolution of inpatient medical care

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