Characteristics of primary care providers who adopted the hospitalist model from 2001 to 2009

Romsai T. Boonyasai, Yu Li Lin, Daniel J. Brotman, Yong Fang Kuo, James Goodwin

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The characteristics of primary care providers (PCPs) who use hospitalists are unknown.

METHODS: Retrospective study using 100% Texas Medicare claims from 2001 through 2009. Descriptive statistics characterized proportion of PCPs using hospitalists over time. Trajectory analysis and multilevel models of 1172 PCPs with ≥20 inpatients in every study year characterized how PCPs adopted the hospitalist model and PCP factors associated with this transition.

RESULTS: Hospitalist use increased between 2001 and 2009. PCPs who adopted the hospitalist model transitioned rapidly. In multilevel models, hospitalist use was associated with US training (odds ratio [OR] 1.46, 95% confidence interval [CI]: 1.23-1.73 in 2007-2009), family medicine specialty (OR: 1.46, 95% CI: 1.25-1.70 in 2007-2009), and having high outpatient volumes (OR: 1.32, 95% CI: 1.20-1.44 in 2007-2009). Over time, relative hospitalist use decreased among female PCPs (OR: 1.91, 95% CI: 1.46-2.50 in 2001-2003; OR: 1.50, 95% CI: 1.15-1.95 in 2007-2009), those in urban locations (OR: 3.34, 95% CI: 2.72-4.09 in 2001-2003; OR: 2.22, 95% CI: 1.82-2.71 in 2007-2009), and those with higher inpatient volumes (OR: 1.05, 95% CI: 0.95-1.18 in 2001-2003; OR: 0.55, 95% CI: 0.51-0.60 in 2007-2009). Longest-practicing PCPs were more likely to transition in the early 2000s, but this effect disappeared by the end of the study period (OR: 1.35, 95% CI: 1.06-1.72 in 2001-2003; OR: 0.92, 95% CI: 0.73-1.17 in 2007-2009). PCPs with practice panels dominated by patients who were white, male, or had comorbidities are more likely to use hospitalists.

CONCLUSIONS: PCP characteristics are associated with hospitalist use. The association between PCP characteristics and hospitalist use has evolved over time.

Original languageEnglish (US)
Pages (from-to)75-82
Number of pages8
JournalJournal of Hospital Medicine
Volume10
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

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Hospitalists
Primary Health Care
Confidence Intervals
Odds Ratio
Inpatients
Multilevel Analysis
Medicare
Comorbidity

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Characteristics of primary care providers who adopted the hospitalist model from 2001 to 2009. / Boonyasai, Romsai T.; Lin, Yu Li; Brotman, Daniel J.; Kuo, Yong Fang; Goodwin, James.

In: Journal of Hospital Medicine, Vol. 10, No. 2, 01.02.2015, p. 75-82.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: The characteristics of primary care providers (PCPs) who use hospitalists are unknown.METHODS: Retrospective study using 100{\%} Texas Medicare claims from 2001 through 2009. Descriptive statistics characterized proportion of PCPs using hospitalists over time. Trajectory analysis and multilevel models of 1172 PCPs with ≥20 inpatients in every study year characterized how PCPs adopted the hospitalist model and PCP factors associated with this transition.RESULTS: Hospitalist use increased between 2001 and 2009. PCPs who adopted the hospitalist model transitioned rapidly. In multilevel models, hospitalist use was associated with US training (odds ratio [OR] 1.46, 95{\%} confidence interval [CI]: 1.23-1.73 in 2007-2009), family medicine specialty (OR: 1.46, 95{\%} CI: 1.25-1.70 in 2007-2009), and having high outpatient volumes (OR: 1.32, 95{\%} CI: 1.20-1.44 in 2007-2009). Over time, relative hospitalist use decreased among female PCPs (OR: 1.91, 95{\%} CI: 1.46-2.50 in 2001-2003; OR: 1.50, 95{\%} CI: 1.15-1.95 in 2007-2009), those in urban locations (OR: 3.34, 95{\%} CI: 2.72-4.09 in 2001-2003; OR: 2.22, 95{\%} CI: 1.82-2.71 in 2007-2009), and those with higher inpatient volumes (OR: 1.05, 95{\%} CI: 0.95-1.18 in 2001-2003; OR: 0.55, 95{\%} CI: 0.51-0.60 in 2007-2009). Longest-practicing PCPs were more likely to transition in the early 2000s, but this effect disappeared by the end of the study period (OR: 1.35, 95{\%} CI: 1.06-1.72 in 2001-2003; OR: 0.92, 95{\%} CI: 0.73-1.17 in 2007-2009). PCPs with practice panels dominated by patients who were white, male, or had comorbidities are more likely to use hospitalists.CONCLUSIONS: PCP characteristics are associated with hospitalist use. The association between PCP characteristics and hospitalist use has evolved over time.",
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AU - Boonyasai, Romsai T.

AU - Lin, Yu Li

AU - Brotman, Daniel J.

AU - Kuo, Yong Fang

AU - Goodwin, James

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BACKGROUND: The characteristics of primary care providers (PCPs) who use hospitalists are unknown.METHODS: Retrospective study using 100% Texas Medicare claims from 2001 through 2009. Descriptive statistics characterized proportion of PCPs using hospitalists over time. Trajectory analysis and multilevel models of 1172 PCPs with ≥20 inpatients in every study year characterized how PCPs adopted the hospitalist model and PCP factors associated with this transition.RESULTS: Hospitalist use increased between 2001 and 2009. PCPs who adopted the hospitalist model transitioned rapidly. In multilevel models, hospitalist use was associated with US training (odds ratio [OR] 1.46, 95% confidence interval [CI]: 1.23-1.73 in 2007-2009), family medicine specialty (OR: 1.46, 95% CI: 1.25-1.70 in 2007-2009), and having high outpatient volumes (OR: 1.32, 95% CI: 1.20-1.44 in 2007-2009). Over time, relative hospitalist use decreased among female PCPs (OR: 1.91, 95% CI: 1.46-2.50 in 2001-2003; OR: 1.50, 95% CI: 1.15-1.95 in 2007-2009), those in urban locations (OR: 3.34, 95% CI: 2.72-4.09 in 2001-2003; OR: 2.22, 95% CI: 1.82-2.71 in 2007-2009), and those with higher inpatient volumes (OR: 1.05, 95% CI: 0.95-1.18 in 2001-2003; OR: 0.55, 95% CI: 0.51-0.60 in 2007-2009). Longest-practicing PCPs were more likely to transition in the early 2000s, but this effect disappeared by the end of the study period (OR: 1.35, 95% CI: 1.06-1.72 in 2001-2003; OR: 0.92, 95% CI: 0.73-1.17 in 2007-2009). PCPs with practice panels dominated by patients who were white, male, or had comorbidities are more likely to use hospitalists.CONCLUSIONS: PCP characteristics are associated with hospitalist use. The association between PCP characteristics and hospitalist use has evolved over time.

AB - BACKGROUND: The characteristics of primary care providers (PCPs) who use hospitalists are unknown.METHODS: Retrospective study using 100% Texas Medicare claims from 2001 through 2009. Descriptive statistics characterized proportion of PCPs using hospitalists over time. Trajectory analysis and multilevel models of 1172 PCPs with ≥20 inpatients in every study year characterized how PCPs adopted the hospitalist model and PCP factors associated with this transition.RESULTS: Hospitalist use increased between 2001 and 2009. PCPs who adopted the hospitalist model transitioned rapidly. In multilevel models, hospitalist use was associated with US training (odds ratio [OR] 1.46, 95% confidence interval [CI]: 1.23-1.73 in 2007-2009), family medicine specialty (OR: 1.46, 95% CI: 1.25-1.70 in 2007-2009), and having high outpatient volumes (OR: 1.32, 95% CI: 1.20-1.44 in 2007-2009). Over time, relative hospitalist use decreased among female PCPs (OR: 1.91, 95% CI: 1.46-2.50 in 2001-2003; OR: 1.50, 95% CI: 1.15-1.95 in 2007-2009), those in urban locations (OR: 3.34, 95% CI: 2.72-4.09 in 2001-2003; OR: 2.22, 95% CI: 1.82-2.71 in 2007-2009), and those with higher inpatient volumes (OR: 1.05, 95% CI: 0.95-1.18 in 2001-2003; OR: 0.55, 95% CI: 0.51-0.60 in 2007-2009). Longest-practicing PCPs were more likely to transition in the early 2000s, but this effect disappeared by the end of the study period (OR: 1.35, 95% CI: 1.06-1.72 in 2001-2003; OR: 0.92, 95% CI: 0.73-1.17 in 2007-2009). PCPs with practice panels dominated by patients who were white, male, or had comorbidities are more likely to use hospitalists.CONCLUSIONS: PCP characteristics are associated with hospitalist use. The association between PCP characteristics and hospitalist use has evolved over time.

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