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

Abstract

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.

The number of inpatient consultations is negatively correlated with patient satisfaction in patients with prolonged hospital stays

“…transitions in care) that cannot be experienced by those with shorter stays. 6,7 Because physician discontinuity and physician communication has previously been shown to negatively impact patient satisfaction, patients with prolonged hospital stays are the best barometers of how these challenges are being met in the inpatient setting. The impact of hospital structural variables, such as continuity of care, on patient satisfaction is best studied by examining the patients who are most impacted by transitions in care.…”

The effect of hospitalist discontinuity on adverse events

“…Key clinical information may be lost during physician‐to‐physician handoffs (eg, at admission, at the end of rotations on service) during hospitalization. Our research group recently found that lower hospital physician continuity was associated with modestly increased hospital costs, but also a trend toward lower readmissions . We speculated that physicians newly taking over patient care from colleagues reassess diagnoses and treatment plans.…”

“…We sought to examine the relationship between hospital physician continuity and the incidence of adverse events (AEs). We combined data from 2 previously published studies by our research group; one investigated the relationship between hospital physician continuity and costs and 30‐day readmissions, the other assessed the impact of unit‐based interventions on AEs …”

Capsule Commentary on Turner et al., The Impact of Hospitalist Discontinuity on Hospital Cost, Readmissions, and Patient Satisfaction

“…1 Discontinuity was measured by modifying two tools that are typically applied in the outpatient rather than inpatient setting: the Usual Provider of Care Index (UPC) 2 and the Number of Physicians Index (NPI). 3 The authors found that discontinuity was associated with increased costs, had no impact on patient satisfaction and trended toward fewer readmissions.…”