Association of hospitalist years of experience with mortality in the hospitalized medicare population

James Goodwin, Habeeb Salameh, Jie Zhou, Siddhartha Singh, Yong Fang Kuo, Ann B. Nattinger

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

IMPORTANCE: Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking. OBJECTIVE: To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. DESIGN, SETTING, AND PARTICIPANTS: We used a 5%sample of national Medicare data of patient and hospital characteristics to build a multilevel logistic regression model to predict mortality as a function of years of experience of the hospitalists. We created 2 cohorts. The first was a cross-sectional cohort of 21 612 hospitalists working between July 1, 2013, and June 30, 2014, with a 5-year look-back period to assess their years of prior experience as a hospitalist, and the second was a longitudinal cohort of 3860 hospitalists in their first year of practice between July 1, 2008, and June 30, 2011, who continued practicing hospital medicine for at least 4 years. MAIN OUTCOMES AND MEASURES: Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome. RESULTS: Among 21 612 hospitalists caring for Medicare inpatients from July 1, 2013, to June 30, 2014, 5445 (25%) had 1 year of experience or less, while 11 596 (54%) had 4 years of experience or more.We then identified 3860 physicians in their first year as hospitalists who continued to practice as hospitalists for 4 years. There was a significant association between hospitalist experience and mortality. Observed 30-day mortality was 10.50% for patients of first-year hospitalists vs 9.97%for patients of hospitalists in their second year. The mortality odds for patients of second-year hospitalists were 0.90 (95%CI, 0.84-0.96) compared with patients of first-year hospitalists. Observed hospital mortality was 3.33%for patients cared for by first-year hospitalists vs 2.96%for second-year hospitalists. (odds ratio, 0.84; 95%CI, 0.75-0.95). For both 30-day and hospital mortality, there was little change in odds of mortality between the second year and subsequent years of experience. CONCLUSIONS AND RELEVANCE: Patients cared for by hospitalists in their first year of practice experience higher mortality. Early-career hospitalists may require additional support to ensure optimal outcomes for their patients.

Original languageEnglish (US)
Pages (from-to)196-203
Number of pages8
JournalJAMA Internal Medicine
Volume178
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Hospitalists
Medicare
Mortality
Population
Hospital Mortality
Logistic Models

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Association of hospitalist years of experience with mortality in the hospitalized medicare population. / Goodwin, James; Salameh, Habeeb; Zhou, Jie; Singh, Siddhartha; Kuo, Yong Fang; Nattinger, Ann B.

In: JAMA Internal Medicine, Vol. 178, No. 2, 01.02.2018, p. 196-203.

Research output: Contribution to journalArticle

Goodwin, James ; Salameh, Habeeb ; Zhou, Jie ; Singh, Siddhartha ; Kuo, Yong Fang ; Nattinger, Ann B. / Association of hospitalist years of experience with mortality in the hospitalized medicare population. In: JAMA Internal Medicine. 2018 ; Vol. 178, No. 2. pp. 196-203.
@article{71cb02becd4048328c50126578b70392,
title = "Association of hospitalist years of experience with mortality in the hospitalized medicare population",
abstract = "IMPORTANCE: Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking. OBJECTIVE: To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. DESIGN, SETTING, AND PARTICIPANTS: We used a 5{\%}sample of national Medicare data of patient and hospital characteristics to build a multilevel logistic regression model to predict mortality as a function of years of experience of the hospitalists. We created 2 cohorts. The first was a cross-sectional cohort of 21 612 hospitalists working between July 1, 2013, and June 30, 2014, with a 5-year look-back period to assess their years of prior experience as a hospitalist, and the second was a longitudinal cohort of 3860 hospitalists in their first year of practice between July 1, 2008, and June 30, 2011, who continued practicing hospital medicine for at least 4 years. MAIN OUTCOMES AND MEASURES: Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome. RESULTS: Among 21 612 hospitalists caring for Medicare inpatients from July 1, 2013, to June 30, 2014, 5445 (25{\%}) had 1 year of experience or less, while 11 596 (54{\%}) had 4 years of experience or more.We then identified 3860 physicians in their first year as hospitalists who continued to practice as hospitalists for 4 years. There was a significant association between hospitalist experience and mortality. Observed 30-day mortality was 10.50{\%} for patients of first-year hospitalists vs 9.97{\%}for patients of hospitalists in their second year. The mortality odds for patients of second-year hospitalists were 0.90 (95{\%}CI, 0.84-0.96) compared with patients of first-year hospitalists. Observed hospital mortality was 3.33{\%}for patients cared for by first-year hospitalists vs 2.96{\%}for second-year hospitalists. (odds ratio, 0.84; 95{\%}CI, 0.75-0.95). For both 30-day and hospital mortality, there was little change in odds of mortality between the second year and subsequent years of experience. CONCLUSIONS AND RELEVANCE: Patients cared for by hospitalists in their first year of practice experience higher mortality. Early-career hospitalists may require additional support to ensure optimal outcomes for their patients.",
author = "James Goodwin and Habeeb Salameh and Jie Zhou and Siddhartha Singh and Kuo, {Yong Fang} and Nattinger, {Ann B.}",
year = "2018",
month = "2",
day = "1",
doi = "10.1001/jamainternmed.2017.7049",
language = "English (US)",
volume = "178",
pages = "196--203",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "2",

}

TY - JOUR

T1 - Association of hospitalist years of experience with mortality in the hospitalized medicare population

AU - Goodwin, James

AU - Salameh, Habeeb

AU - Zhou, Jie

AU - Singh, Siddhartha

AU - Kuo, Yong Fang

AU - Nattinger, Ann B.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - IMPORTANCE: Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking. OBJECTIVE: To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. DESIGN, SETTING, AND PARTICIPANTS: We used a 5%sample of national Medicare data of patient and hospital characteristics to build a multilevel logistic regression model to predict mortality as a function of years of experience of the hospitalists. We created 2 cohorts. The first was a cross-sectional cohort of 21 612 hospitalists working between July 1, 2013, and June 30, 2014, with a 5-year look-back period to assess their years of prior experience as a hospitalist, and the second was a longitudinal cohort of 3860 hospitalists in their first year of practice between July 1, 2008, and June 30, 2011, who continued practicing hospital medicine for at least 4 years. MAIN OUTCOMES AND MEASURES: Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome. RESULTS: Among 21 612 hospitalists caring for Medicare inpatients from July 1, 2013, to June 30, 2014, 5445 (25%) had 1 year of experience or less, while 11 596 (54%) had 4 years of experience or more.We then identified 3860 physicians in their first year as hospitalists who continued to practice as hospitalists for 4 years. There was a significant association between hospitalist experience and mortality. Observed 30-day mortality was 10.50% for patients of first-year hospitalists vs 9.97%for patients of hospitalists in their second year. The mortality odds for patients of second-year hospitalists were 0.90 (95%CI, 0.84-0.96) compared with patients of first-year hospitalists. Observed hospital mortality was 3.33%for patients cared for by first-year hospitalists vs 2.96%for second-year hospitalists. (odds ratio, 0.84; 95%CI, 0.75-0.95). For both 30-day and hospital mortality, there was little change in odds of mortality between the second year and subsequent years of experience. CONCLUSIONS AND RELEVANCE: Patients cared for by hospitalists in their first year of practice experience higher mortality. Early-career hospitalists may require additional support to ensure optimal outcomes for their patients.

AB - IMPORTANCE: Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking. OBJECTIVE: To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. DESIGN, SETTING, AND PARTICIPANTS: We used a 5%sample of national Medicare data of patient and hospital characteristics to build a multilevel logistic regression model to predict mortality as a function of years of experience of the hospitalists. We created 2 cohorts. The first was a cross-sectional cohort of 21 612 hospitalists working between July 1, 2013, and June 30, 2014, with a 5-year look-back period to assess their years of prior experience as a hospitalist, and the second was a longitudinal cohort of 3860 hospitalists in their first year of practice between July 1, 2008, and June 30, 2011, who continued practicing hospital medicine for at least 4 years. MAIN OUTCOMES AND MEASURES: Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome. RESULTS: Among 21 612 hospitalists caring for Medicare inpatients from July 1, 2013, to June 30, 2014, 5445 (25%) had 1 year of experience or less, while 11 596 (54%) had 4 years of experience or more.We then identified 3860 physicians in their first year as hospitalists who continued to practice as hospitalists for 4 years. There was a significant association between hospitalist experience and mortality. Observed 30-day mortality was 10.50% for patients of first-year hospitalists vs 9.97%for patients of hospitalists in their second year. The mortality odds for patients of second-year hospitalists were 0.90 (95%CI, 0.84-0.96) compared with patients of first-year hospitalists. Observed hospital mortality was 3.33%for patients cared for by first-year hospitalists vs 2.96%for second-year hospitalists. (odds ratio, 0.84; 95%CI, 0.75-0.95). For both 30-day and hospital mortality, there was little change in odds of mortality between the second year and subsequent years of experience. CONCLUSIONS AND RELEVANCE: Patients cared for by hospitalists in their first year of practice experience higher mortality. Early-career hospitalists may require additional support to ensure optimal outcomes for their patients.

UR - http://www.scopus.com/inward/record.url?scp=85041684788&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041684788&partnerID=8YFLogxK

U2 - 10.1001/jamainternmed.2017.7049

DO - 10.1001/jamainternmed.2017.7049

M3 - Article

VL - 178

SP - 196

EP - 203

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 2

ER -