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 Goodwin

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)441-447
Number of pages7
JournalJournal of Hospital Medicine
Volume6
Issue number8
DOIs
StatePublished - Oct 2011

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Continuity of Patient Care
Medicare
Inpatients
Physicians
Hospitalists
Hospitalization
Fee-for-Service Plans
Social Class
Chronic Obstructive Pulmonary Disease
Comorbidity
Pneumonia
Patient Care
Heart Failure
Delivery of Health Care
Population

ASJC Scopus subject areas

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

Cite this

Trends in inpatient continuity of care for a cohort of Medicare patients 1996-2006. / Fletcher, Kathlyn E.; Sharma, Gulshan; Zhang, Dong; Kuo, Yong Fang; Goodwin, James.

In: Journal of Hospital Medicine, Vol. 6, No. 8, 10.2011, p. 441-447.

Research output: Contribution to journalArticle

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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.",
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