Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists

Abstract

IMPORTANCE A physician's prior experience caring for a patient may be associated with patient outcomes and care patterns during and after hospitalization.OBJECTIVE To examine differences in the use of health care resources and outcomes among hospitalized patients cared for by hospitalists, their own primary care physicians (PCPs), or other generalists. DESIGN, SETTING, AND PARTICIPANTSThis retrospective study analyzed admissions for the 20 most common medical diagnoses among elderly fee-for-service Medicare patients from January 1 through December 31, 2013. Patients had at least 1 previous encounter with an outpatient clinician within the 365 days before admission, and diagnoses were restricted to the 20 most common diagnosis related groups. Data were collected from Medicare Parts A and B claims data, and outcomes were analyzed from January 1, 2013, through January 31, 2014.EXPOSURES Physician types included hospitalists, PCPs (ie, the physicians who provided a plurality of ambulatory visits in the year preceding admission), or generalists (not the patients' PCPs). MAIN OUTCOMES AND MEASURESNumber of in-hospital specialist consultations, length of stay, discharge site, all-cause 7-and 30-day readmission rates, and 30-day mortality.RESULTS A total of 560 651 admissions were analyzed (41.9% men and 59.1% women; mean [SD] age, 80 [8] years). Patients' physicians were hospitalists in 59.7% of admissions; PCPs, in 14.2%; and other generalists, in 26.1%. Primary care physicians used consultations 3% more (relative risk, 1.03; 95% CI, 1.02-1.05) and other generalists used consultations 6% more (relative risk, 1.06; 95% CI, 1.05-1.07) than hospitalists. Lengths of stay were 12% longer among patients cared for by PCPs (adjusted incidence rate ratio, 1.12; 95% CI, 1.11-1.13) and 6% longer among those cared for by other generalists (adjusted incidence rate ratio, 1.06; 95% CI, 1.05-1.07) compared with patients cared for by hospitalists. However, PCPs were more likely to discharge patients home (adjusted odds ratio [AOR], 1.14; 95% CI, 1.11-1.17), whereas other generalists were less likely to do so (AOR, 0.94; 95% CI, 0.92-0.96). Relative to hospitalists, patients cared for by PCPs had similar readmission rates at 7 days (AOR, 0.98; 95% CI, 0.96-1.01) and 30 days (AOR, 1.02; 95% CI, 0.99-1.04), whereas other generalists' readmission rates were greater than hospitalists' rates at 7 (AOR, 1.05; 95% CI, 1.02-1.07) and 30 (AOR, 1.04; 95% CI, 1.03-1.06) days. Patients cared for by PCPs had lower 30-day mortality than patients of hospitalists (AOR, 0.94; 95% CI, 0.91-0.97), whereas the mortality rate of patients of other generalists was higher (AOR, 1.09; 95% CI, 1.07-1.12). CONCLUSIONS AND RELEVANCE A PCP's prior experience with a patient may be associated with inpatient use of resources and patient outcomes. Patients cared for by their own PCP had slightly longer lengths of stay and were more likely to be discharged home but also were less likely to die within 30 days compared with those cared for by hospitalists or other genera...

Hospitalists staffing levels and hospital performance

“…Hospitalists currently deliver inpatient care in around 75 percent of hospitals in the United States . However, since hospitalists, as an internal medicine specialty, have not been around for a long time, questions about the value added by hospitalists remain . Our findings support previous studies that found a positive relationship between hospitalists and lower readmission rates, resource use, and length of stay .…”

“…However, since hospitalists, as an internal medicine specialty, have not been around for a long time, questions about the value added by hospitalists remain . Our findings support previous studies that found a positive relationship between hospitalists and lower readmission rates, resource use, and length of stay . Employment ensures hospitalists' commitment to the organization and allows hospitalists to attain leadership roles in the hospital.…”

Prognostic Implications of a Point‐of‐Care Ultrasound Examination on Hospital Ward Admission

“…Any individual resident bias in performing POCUS examinations was mitigated by the large variety of patient presentations and substantial number of residents sampled in this study, which represents one of the largest single‐center experiences of its kind. Although it was anticipated that residents would preferably perform CLUE on patients with cardiopulmonary conditions or more ill noncardiac presentations, it is noteworthy that 33% of CLUE US applications lacked all of the cardiopulmonary signs; that 35% of patients had been discharged within 2 days; and that the average length of stay for this acutely admitted study population, 5.6 ± 8.1 days, was similar to the 5‐day rate reported in national databases of total admissions. It is unlikely that consecutive sampling of all admissions would have changed the study's findings, and it would have made the data less applicable to practice in different hospitals.…”

Postacute care outcomes and medicare payments for patients treated by physicians and advanced practitioners who specialize in nursing home practice

“…However, more recent data suggest that fewer primary care physicians follow their patients across settings. For example, a patient's primary care physician was the hospital attending in only 14.2 percent of admissions by Medicare beneficiaries in 2013 …”