Inpatient-Outpatient Transitions for Patients with Resident Primary Care Physicians: Access and Readmission.
Am J Med. 2014 Apr 22;
Authors: Doctoroff L, McNally D, Vanka A, Nall R, Mukamal KJ
BACKGROUND: Transition from hospitalization to post-discharge care is a vulnerable period for patients. How the experience of this transition differs for patients with resident primary care physicians is unknown.
METHODS: In a single, large academic primary care practice, we examined an inception cohort of consecutive hospitalizations and post-discharge visits of hospitalized patients with resident or faculty primary care physicians between 2008 and 2013. We compared patient demographics, readmission risk, and access to outpatient care between resident and faculty primary care physicians, using generalized estimating equations to account for repeated hospitalizations.
RESULTS: We documented 8161 hospitalizations among patients with resident primary care physicians and 20844 for faculty primary care physicians. Hospitalized patients with resident primary care physicians were generally younger, more likely to be on Medicaid, and more likely to be African-American (p<0.001). Patients with resident primary care physicians were less likely to be seen within 7 and 30 days of discharge (adjusted relative risks 0.83; 95% confidence interval (CI), 0.81-0.93 at 7 days, 0.88; 95% CI, 0.85-0.92 at 30 days), and had an increased risk of readmission within 30 days (adjusted odds ratio 1.25 95% CI,1.13-1.37). They were also considerably less likely to see their own provider at first follow-up (relative risk 0.55; 95% CI, 0.52-0.59).
CONCLUSIONS: Hospitalized patients with resident primary care physicians had lower rates of timely post-discharge follow up, higher rates of readmission, and a lower likelihood of seeing their own provider than did patients with faculty primary care physicians. These findings highlight the challenges facing academic centers for patients with resident primary care physicians.
PMID: 24768966 [PubMed - as supplied by publisher]