The independent association of provider and information continuity on outcomes after hospital discharge: Implications for hospitalists§

Authors


  • This study was conducted using funding from Canadian Institutes for Health Research and the Physicians' Services Incorporated Foundation. Dr. Bell is supported by a Canadian Institutes of Health Research and Canadian Patient Safety Institute chair in Patient Safety and Continuity of Care.

  • Preliminary results of this study were presented at the Annual Meeting of the Society for General Internal Medicine in Toronto May 2007.

  • §

    Disclosure: None of the authors have any potential conflicts of interest, financial interests, relationships, or affiliations relevant to the subject of their manuscript. Dr. van Walraven had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study was conducted using funding from Canadian Institutes for Health Research and the Physicians' Services Incorporated Foundation. Neither funding agency had any role in the conduct of the study. Dr. Forster is a Career Scientist with the Ontario Ministry of Health and Long Term Care.

Abstract

BACKGROUND:

Since hospitalist physicians do not frequently see patients in follow-up after discharge from the hospital, patient continuity of care will decrease. To determine how this influenced patient outcomes, we examined the independent association of several physician continuity and information continuity measures on death or urgent readmission after discharge from hospital.

DESIGN:

Multicenter, prospective cohort study of patients discharged to the community after elective or emergency hospitalization. We measured three physician continuity scores (preadmission; hospital; and postdischarge) and two information continuity scores (discharge summary; postdischarge visit information) as time-dependent covariates. Continuity scores ranged from 0 (perfect discontinuity) to 1 (perfect continuity). The primary outcomes were time to all-cause death or urgent readmission.

RESULTS:

A total of 3876 people were followed for a median of 175 days. Death rate was 2.6 events per 100 patient-years observation (pys) (95% confidence interval [CI], 2.0-3.4) and urgent readmission rate was 19.6 events per 100 pys (95% CI, 15.9-24.3). After adjusting for important covariates and other continuity scores, increased preadmission physician continuity was independently associated with a decreased risk of urgent readmission (adjusted hazard ratio 0.94 [95% CI, 0.91-0.98] for each absolute increase in continuity of 0.1). Other continuity measures—including hospital physician continuity—were not associated with either outcome.

CONCLUSIONS:

After discharge from the hospital, increased continuity with physicians who routinely treated the patient prior to the admission was significantly and independently associated with a decreased risk of urgent readmission. These data suggest that continuity with the hospital physician after discharge did not independently influence the risk of patient death or urgent readmission. Journal of Hospital Medicine 2010;5:398–405. © 2010 Society of Hospital Medicine.

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