PMID- 25523358
OWN - NLM
STAT- MEDLINE
DCOM- 20151204
LR  - 20220309
IS  - 1553-5606 (Electronic)
IS  - 1553-5592 (Linking)
VI  - 10
IP  - 3
DP  - 2015 Mar
TI  - The effect of hospitalist discontinuity on adverse events.
PG  - 147-51
LID - 10.1002/jhm.2308 [doi]
AB  - BACKGROUND: Patient-physician continuity is difficult to achieve in hospital 
      settings because of the need to provide care continuously. The impact of hospital 
      physician discontinuity on patient safety is unknown. OBJECTIVE: To determine the 
      association between hospital physician continuity and the incidence of adverse 
      events (AEs). DESIGN: Retrospective observational study using multivariable 
      models to adjust for patient characteristics. PARTICIPANTS: Patients admitted to 
      a nonteaching hospitalist service in a large academic hospital between March 1, 
      2009 and December 31, 2011. MAIN MEASURE(S): Two measures of continuity were 
      used. The Number of Physicians Index (NPI) was the total number of unique 
      hospitalists caring for a patient. The Usual Provider of Care (UPC) Index was the 
      proportion of encounters with the most frequently encountered hospitalist. 
      Outcome measures were AEs detected by automated queries of information systems 
      and confirmed by 2 physician researchers. KEY RESULTS: Our analysis included data 
      from 474 hospitalizations. In unadjusted models, each 1-unit increase in the NPI 
      (ie, less continuity) was significantly associated with the incidence of 1 or 
      more AEs (odds ratio = 1.75; P < 0.001). However, UPC was not associated with 
      incidence of AEs. Across all adjusted models, neither NPI nor UPC was 
      significantly associated with the incidence of AEs. The direction of the effect 
      of discontinuity on AEs was also inconsistent across models. CONCLUSIONS: 
      Hospitalist physician continuity does not appear to be associated with the 
      incidence of AEs. Because hospital care is provided by teams of clinicians, 
      future research should evaluate the impact of team complexity and dynamics on 
      patient outcomes.
CI  - (c) 2014 Society of Hospital Medicine.
FAU - O'Leary, Kevin J
AU  - O'Leary KJ
AD  - Division of Hospital Medicine, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois.
FAU - Turner, Jonathan
AU  - Turner J
FAU - Christensen, Nicholas
AU  - Christensen N
FAU - Ma, Madeleine
AU  - Ma M
FAU - Lee, Jungwha
AU  - Lee J
FAU - Williams, Mark V
AU  - Williams MV
FAU - Hansen, Luke O
AU  - Hansen LO
LA  - eng
GR  - R18 HS019630/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20141219
PL  - United States
TA  - J Hosp Med
JT  - Journal of hospital medicine
JID - 101271025
SB  - IM
CIN - J Hosp Med. 2015 Sep;10(9):642. PMID: 26336859
CIN - J Hosp Med. 2015 Sep;10(9):643-4. PMID: 26336860
MH  - Adult
MH  - Aged
MH  - Continuity of Patient Care/*standards/trends
MH  - Female
MH  - Hospitalists/*standards/trends
MH  - *Hospitalization/trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Safety/*standards
MH  - *Physician-Patient Relations
MH  - Random Allocation
MH  - Retrospective Studies
EDAT- 2014/12/20 06:00
MHDA- 2015/12/15 06:00
CRDT- 2014/12/20 06:00
PHST- 2014/09/29 00:00 [received]
PHST- 2014/11/18 00:00 [revised]
PHST- 2014/11/30 00:00 [accepted]
PHST- 2014/12/20 06:00 [entrez]
PHST- 2014/12/20 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
AID - 10.1002/jhm.2308 [doi]
PST - ppublish
SO  - J Hosp Med. 2015 Mar;10(3):147-51. doi: 10.1002/jhm.2308. Epub 2014 Dec 19.