Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists

Meltzer, David O.; Manning, Willard G.; Morrison, Jeanette; Shah, Manish N.; Jin, Lei; Guth, Todd; Levinson, Wendy

doi:10.7326/0003-4819-137-11-200212030-00007

Cited by 302 publications

(316 citation statements)

References 19 publications

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“…18 Albumin and creatinine values were also used as surrogates for overall illness severity. 13,[19][20][21][22][23] In addition, we calculated the Laboratory-based Acute Physiology Score (LAPS) to measure the severity of illness. 24,25 To create diagnostic variables, each admission's primary ICD-9 code was classified using the Healthcare Cost and Utilization Project database.…”

Section: Admission-level Covariatesmentioning

confidence: 99%

Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

Southern

Arnsten

2015

J GEN INTERN MED

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Section: Admission-level Covariatesmentioning

confidence: 99%

Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

Southern

Arnsten

2015

J GEN INTERN MED

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“…Commonly, hospital-based physicians, including hospitalists, and medical and surgical residents in academic institutions, work exclusively in the hospital and care for the majority of hospitalized patients. [20][21][22][23][24][25][26] Oftentimes, the hospital physician is first introduced to their patient at hospital admission and must rely on the history, physical exam and medical record when making medical decisions. [27][28][29][30][31] For this reason, the hospital physician may be unaware of a patient's drug or alcohol use or mental illness, all risk factors for opioid misuse.…”

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

et al. 2015

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BACKGROUND: Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use. OBJECTIVE: We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge. DESIGN: This was a retrospective cohort study. PARTICIPANTS: From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital. MAIN MEASURE: Chronic opioid use 1 year post discharge. KEY RESULTS: Twenty-five percent of opioid naïve patients (n=1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3 % versus 3.5 %, p<0.001), acute pain (2.7 % versus 1.0 %, p<0.001), chronic pain at admission (12.1 % versus 3.3 %, p<0.001) or surgery during their hospitalization (65.1 % versus 18.4 %, p<0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7 % versus 20.7 %, p<0.001) and mental health disorders (23.9 % versus 31.4 %, p<0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1 % versus 1.3 %, p<0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR=4.90, 95 % CI 3.22-7.45) and greater subsequent opioid refills (AOR=2.67, 95 % CI 2.29-3.13) 1 year post discharge compared to no opioid receipt. CONCLUSION:Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.

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“…The magnitude of hospitalist involvement in residency training may have important implications. Beyond the financial significance of hospitalists at academic teaching hospitals, 21 only a few studies have addressed their impact on resident education. On the monthly evaluations at the University of California, San Francisco (San Francisco, CA), residents' satisfaction with their attendings was significantly higher when the physician was a hospitalist rather than a traditional faculty member.…”

Section: Discussionmentioning

confidence: 99%

Hospitalist involvement in internal medicine residencies

Beasley

McBride

McDonald

2009

Journal of Hospital Medicine

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Disclosure: Nothing to report. CONTEXT:The ways hospitalists interact with and contribute to internal medicine residencies in the United States have been described locally, but have not been documented on a national level. OBJECTIVES:To describe the penetration of hospitalists into medicine residency faculty nationally, and document their contributions to teaching activities. MEASUREMENTS: Number of teaching hospitals utilizing hospitalists, number of programs utilizing hospitalists to teach, hospitalist teaching duties, and number with hospitalist tracks. RESULTS:In 2005, program directors recalled 54% of teaching hospitals employed hospitalists before and 73% after implementation of work-hour limitations. Of those employing hospitalists, 92% of programs in the Northeast and West used them to teach. Two years later, the Midwest (78%) and South (76%) continued to lag behind in the proportion of teaching hospitalists. Specific teaching activities of hospitalists included: attending on teaching service (92%), conducting rounds (81%), observation of clinical skills (67%), lectures (68%), and morning report (52%). Seven percent of program directors reported other duties of hospitalists, including: supervising procedures, reviewing night float patients, serving as associate program directors, and writing curricula. Eleven percent of training programs had hospitalist tracks. CONCLUSIONS:As hospitalists have become prevalent and have become efficient clinicians in community and university hospitals, the majority of internal medicine residencies have enlisted them to provide rounds, lectures, and bedside teaching. A small number of residencies are beginning to develop tracks to facilitate this new career option for graduates.

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Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists

Cited by 302 publications

References 19 publications

Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

Hospitalist involvement in internal medicine residencies

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