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Trends in inpatient continuity of care for a cohort of Medicare patients 1996–2006§

Authors

  • Kathlyn E. Fletcher MD, MA,

    Corresponding author
    1. Division of Primary Care, Clement J. Zablocki VAMC and Division of General Internal Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
    • PC Division, Clement J. Zablocki VAMC, 5000 W. National Ave., Milwaukee, WI 53295
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    • Telephone: 414-384-2000, ext. 46450; Fax: 414-382-5017

  • Gulshan Sharma MD,

    1. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    2. Sealy Center of Aging, University of Texas Medical Branch, Galveston, Texas
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  • Dong Zhang PhD,

    1. Sealy Center of Aging, University of Texas Medical Branch, Galveston, Texas
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  • Yong-Fang Kuo PhD,

    1. Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    2. Sealy Center of Aging, University of Texas Medical Branch, Galveston, Texas
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  • James S. Goodwin MD

    1. Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    2. Sealy Center of Aging, University of Texas Medical Branch, Galveston, Texas
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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.

  • 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.

  • §

    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).

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.

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