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Original Research
Article first published online: 11 OCT 2011
DOI: 10.1002/jhm.916
Copyright © 2011 Society of Hospital Medicine
Additional Information
How to Cite
Fletcher, K. E., Sharma, G., Zhang, D., Kuo, Y.-F. and Goodwin, J. S. (2011), Trends in inpatient continuity of care for a cohort of Medicare patients 1996–2006. J. Hosp. Med., 6: 438–444. doi: 10.1002/jhm.916
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Funding Source: This work was supported by grants R01-AG033134, K08-AG03158302, and K05-CA134923 from the National Institutes of Health.
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Disclosure: The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
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Conflicts of Interest: Dr. Fletcher: Relevant to this project: UTMB-funded travel; others: ACGME, VA HSRD grants; Dr. Sharma: NIH-K08 (K08-AG031583); Dr. Zhang: none; Dr. Kuo: none; Dr. Goodwin: NIA (K05-CA134923, R01-AG033134).
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Telephone: 414-384-2000, ext. 46450; Fax: 414-382-5017
Publication History
- Issue published online: 11 OCT 2011
- Article first published online: 11 OCT 2011
- Manuscript Accepted: 13 FEB 2011
- Manuscript Revised: 7 FEB 2011
- Manuscript Received: 30 JUN 2010
Abstract
BACKGROUND:
Little is known about how changes in health care delivery, such as the use of hospitalists, have impacted inpatient continuity.
OBJECTIVE:
To examine the extent of inpatient discontinuity (ie, being seen by more than one generalist physician) during hospitalization for selected patients.
DESIGN:
Retrospective cohort.
SETTING:
4,859 US hospitals.
PATIENTS:
Medicare fee-for-service beneficiaries hospitalized for chronic obstructive pulmonary disease (COPD), pneumonia, and congestive heart failure (CHF) from 1996 through 2006.
MEASUREMENTS:
We analyzed the proportion of Medicare beneficiaries who received care from 1, 2, or 3 or more generalist physicians during hospitalization. We also examined the factors associated with continuity during the hospitalization.
RESULTS:
Between 1996 and 2006, 64.3% of patients received care from 1, 26.9% from 2 and 8.8% from 3 or more generalist physicians during hospitalization. The percentage of patients who received care from one generalist physician declined from 70.7% in 1996 to 59.4% in 2006 (P < 0.001). In a multivariable analysis, continuity with one generalist physician decreased by 5.5% (95% CI, 5.3%–5.6%) per year between 1996 and 2006. Patients receiving all care from hospitalists saw fewer generalist physicians compared to those who received all care from a non-hospitalist or both. Older patients, females, non-Hispanic whites, those with higher socioeconomic status, and those with more comorbidities were more likely to receive care from multiple generalist physicians.
LIMITATIONS:
The results may not be generalizable to non-Medicare populations.
CONCLUSIONS:
Hospitalized patients are experiencing less continuity than 10 years ago. The hospitalist model of care does not appear to play a role in this discontinuity. Journal of Hospital Medicine 2011;6:441–447. © 2011 Society of Hospital Medicine.