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

Kathlyn E. Fletcher, Gulshan Sharma, Dong Zhang, Yong Fang Kuo, James S. Goodwin

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)438-444
Number of pages7
JournalJournal of hospital medicine
Issue number8
StatePublished - Oct 2011

ASJC Scopus subject areas

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


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