Association of Inpatient Continuity of Care With Complications and Length of Stay Among Hospitalized Medicare Enrollees

Link to article at PubMed

JAMA Netw Open. 2021 Aug 2;4(8):e2120622. doi: 10.1001/jamanetworkopen.2021.20622.


IMPORTANCE: Continuity in primary care is associated with improved outcomes, but less information is available on the association of continuity of care in the hospital with hospital complications.

OBJECTIVE: To assess whether the number of hospitalists providing care is associated with subsequent hospital complications and length of stay.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used multilevel logistic regression models to analyze Medicare claims for medical admissions from 2016 to 2018 with a length of stay longer than 4 days. Admissions with multiple charges on the same day from a hospitalist or an intensive care unit (ICU) stay during hospital days 1 to 3 were excluded. The data were accessed and analyzed from November 1, 2020, to April 30, 2021.

EXPOSURES: The number of different hospitalists who submitted charges during hospital days 1 to 3.

MAIN OUTCOMES AND MEASURES: Overall length of stay and transfer to ICU or a new diagnosis of drug toxic effects on hospital day 4 or later.

RESULTS: Among the 617 680 admissions, 362 376 (58.7%) were women, with a mean (SD) age of 80.2 (8.4) years. In 306 037 admissions (49.6%), the same hospitalist provided care on days 1 to 3, while 2 hospitalists provided care in 274 658 admissions (44.5%), and 3 hospitalists provided care in 36 985 admissions (6.0%). There was no significant association between the number of different hospitalists on days 1 to 3 and either length of stay or subsequent ICU transfers. Admissions seeing 2 or 3 hospitalists had a slightly greater adjusted odds of subsequent new diagnoses of drug toxic effects (2 hospitalists: odds ratio [OR], 1.04; 95% CI, 1.02-1.07; 3 hospitalists: OR, 1.07; 95% CI, 1.03-1.12).

CONCLUSIONS AND RELEVANCE: There was little evidence that receiving care from multiple hospitalists was associated with worse outcomes for patients receiving all their general medical care from hospitalists.

PMID:34383060 | DOI:10.1001/jamanetworkopen.2021.20622

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