Higher hospitalist continuity of care linked to improved clinical outcomes

1. In this retrospective cohort analysis, patients admitted under services with greater hospitalist continuity of care had lower 30-day mortality compared to lower-continuity hospitalist services.

2. Higher continuity hospitalist services also had improved readmission rates and lower associated discharge costs.

Evidence Rating Level: 3 (Average)       

Study Rundown: Central to the physician-patient relationship is the continuity of clinical care, an aspect that has also been linked to improved clinical outcomes in the outpatient, community, and transitional care settings. The optimization of physician scheduling seeks to balance workload and patient care. The impact of physician continuity on inpatient-admissions remains an important consideration. The current study sought to evaluate the impact of continuity on the care of patients admitted under hospitalist services and its impact on clinical outcomes for short medical admissions. The study found that the highest quartile for continuity of care demonstrated improved overall survival, reduced readmissions, higher rates of discharge home, and lower associated healthcare costs.

The main strength of the study is the large sample size of patient admissions with a varied degree of continuity. The major limitations of the study include the retrospective design, allowing for selection bias as patients with more complex medical problems may have had a higher likelihood of requiring care from multiple physicians.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality

In-Depth [retrospective cohort]: This study was a retrospective cohort analysis from Texas Medicare data from 2014-2016. The study included all patients admitted to a hospitalist service for 3-6 days with a maximum of one evaluation and management charge per day. The study excluded patients with an intensive care unit stay. Continuity of care was evaluated as a percentage of working days in that year with a block of 7 or more consecutive working days. The primary outcome was 30-day mortality while secondary outcomes were 30-day readmission rates, health care costs, and discharge destinations.

The study found that patients under the care of hospitalists in the highest quartile for continuity had a lower 30-day mortality (adjusted odds ratio [aOR], 0.88; 95%CI, 0.81-0.95), readmission rates (aOR, 0.94; 95%CI, 0.90-0.99), higher rates of discharge to the home (aOR, 1.08; 95%CI, 1.03-1.13), and lower 30-day post-discharge costs (−$223; 95%CI, −$441 to −$7).

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