Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study

Verma, Amol A.; Guo, Yishan; Kwan, Janice; Lapointe‐Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Cram, Peter; Dhalla, Irfan A.; Hwang, Stephen W.; Laupacis, Andreas; Mamdani, Muhammad; Shadowitz, Steven; Upshur, Ross; Reid, Robert J.; Razak, Fahad

doi:10.9778/cmajo.20170097

Cited by 94 publications

(153 citation statements)

References 20 publications

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“…The costliest conditions per admission were sepsis and the group of delirium, dementia, and cognitive disorders. Although referral patterns and models of care vary across participating hospitals, 6 the prevalence of conditions in our analysis was highly correlated across most sites.…”

Section: Discussionmentioning

confidence: 92%

“…We focus on median and total costs because hospital costs in this population are highly right-skewed. 6 To assess the generalizability of our findings across hospital sites, we compared the prevalence of the 20 most common discharge diagnoses at each hospital with the prevalence of those conditions at the other 6 hospitals combined using Pearson correlation coefficients. We also reported the number of the 20 most common conditions overall that were among the top 20 conditions at each site.…”

Section: Resultsmentioning

confidence: 99%

“…We conducted a retrospective cross-sectional study involving 7 hospital sites that were participating in the General Medicine Inpatient Initiative Study (GEMINI) 6 in the Toronto area, Canada. We included all patients discharged between April 1, 2010 and March 31, 2015 who were admitted to or discharged from an inpatient GIM service.…”

Section: Design and Settingmentioning

confidence: 99%

“…GIM services were defined as inpatient services in which the most responsible attending physician cared for general medicine patients in a hospitalist model of care. 5 The GIM services at GEMINI hospitals have previously been described in detail 6 and include teaching and non-teaching teams that collaborate with allied health professionals and are staffed by internists (93%) or family physicians (7%). The GEMINI sites include 5 academic health centers and 2 large community-based teaching hospitals.…”

Section: Design and Settingmentioning

confidence: 99%

“…At 7 teaching hospital sites in Toronto, Canada, GIM admissions accounted for 39% of emergency department admissions to hospital and 24% of hospital bed-days. 6 The purpose of our study was to determine the prevalence and cost of conditions treated on GIM inpatient services at these hospitals to inform healthcare delivery, quality improvement, and future research.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study

et al. 2018

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GIM services care for a markedly heterogeneous population but the most common conditions were similar across 7 hospitals. The diversity of conditions cared for in GIM may be challenging for healthcare delivery and quality improvement. Initiatives that cut across individual diseases to address processes of care, patient experience, and functional outcomes may be more relevant to a greater proportion of the GIM population than disease-specific efforts.

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Section: Discussionmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Design and Settingmentioning

confidence: 99%

Section: Design and Settingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study

et al. 2018

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Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians

Sergeant

Saha

Shin³

et al. 2021

JAMA Health Forum

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IMPORTANCE Hospitalized medical patients cared for by female physicians may have decreased mortality rates compared with patients of male physicians. However, this association has yet to be assessed outside of the US, and little is known about factors that may explain this difference.OBJECTIVE To determine whether mortality, other hospital outcomes, and processes of care differed between the patients cared for by female and male physicians. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included patients admitted to general medical wards at 7 hospitals in Ontario, Canada, between April 1, 2010, and October 31, 2017. The association of physician gender with patient outcomes was examined while adjusting for hospital fixed effects, patient characteristics, physician characteristics, and processes of care. All patients were admitted to a general internal medicine service through the emergency department and were cared for by a general internist or family physician-hospitalist. Patients were excluded if length of stay was greater than 30 days or if the attending physician cared for less than 100 hospitalized general medicine patients over the study period. Statistical analyses were performed from October 15, 2020, to May 8, 2021. MAIN OUTCOMES AND MEASURESIn-hospital mortality, length of stay, intensive care unit admission, 30-day readmissions, and process-of-care measures (blood tests, medications, imaging, endoscopy, and interventional radiology services). RESULTSA total of 171 625 hospitalized patients with a median age of 73 years (interquartile range, 56-84 years) were included (84 221 men [49.1%], 87 402 women [50.9%], and 2 patients with unspecified sex). Patients were cared for by 172 attending physicians (54 female physicians [31.4%] and 118 male physicians [68.6%]). In fully adjusted models, female physicians ordered more imaging tests, including computed tomography

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Association of the Trauma of Hospitalization With 30-Day Readmission or Emergency Department Visit

et al. 2019

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IMPORTANCE Trauma of hospitalization refers to the depersonalizing and stressful experience of a hospital admission and is hypothesized to increase the risk of readmission after discharge. OBJECTIVES To characterize the trauma of hospitalization by measuring patient-reported disturbances in sleep, mobility, nutrition, and mood among medical inpatients, and to examine the association between these disturbances and the risk of unplanned return to hospital after discharge. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study enrolled participants between September 1, 2016, and September 1, 2017, at 2 academic hospitals in Toronto, Canada. Participants were adults admitted to the internal medicine ward for more than 48 hours. Participants were interviewed before discharge using a standardized questionnaire to assess sleep, mobility, nutrition, and mood. Responses for each domain were dichotomized as disturbance or no disturbance. Disturbance in 3 or 4 domains (the upper tertile) was considered high trauma of hospitalization, and disturbance in 0 to 2 domains (the lower 2 tertiles) was considered low trauma. MAIN OUTCOME AND MEASURES The primary outcome was readmission or emergency department visit within 30 days of discharge. The association between trauma of hospitalization and the primary outcome was examined using logistic regression, adjusted for age; sex; length of stay; Charlson Comorbidity Index Score; Laboratory-Based Acute Physiology Score; and baseline disturbances in sleep, mobility, nutrition, and mood. RESULTS A total of 207 patients participated, of whom 82 (39.6%) were women and 125 (60.4%) were men, with a mean (SD) age of 60.3 (16.8) years. Among the 207 participants, 75 (36.2%) reported sleep disturbance, 162 (78.3%) reported mobility disturbance, 114 (55.1%) reported nutrition disturbance, and 48 (23.2%) reported mood disturbance. Nearly all participants (192 [92.8%]) described a disturbance in at least 1 domain, and 61 participants (29.5%) had high trauma exposure. A statistically significant 15.8% greater absolute risk of readmission or emergency department visit was found in participants with high trauma (37.7%; 95% CI, 25.9%-51.1%) compared with those with low trauma (21.9%; 95% CI, 15.7%-29.7%), which remained statistically significant after adjusting for baseline characteristics (adjusted odds ratio, 2.52; 95% CI, 1.24-5.17; P = .01) and propensity score matching (odds ratio, 2.47; 95% CI, 1.11-5.73; P = .03). CONCLUSIONS AND RELEVANCE Disturbances in sleep, mobility, nutrition, and mood were common in medical inpatients; such trauma of hospitalization may be associated with a greater risk of 30-day readmission or emergency department visit after hospital discharge.

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Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study

Cited by 94 publications

References 20 publications

Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study

Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study

Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians

Association of the Trauma of Hospitalization With 30-Day Readmission or Emergency Department Visit

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