Trends in inpatient continuity of care for a cohort of Medicare patients 1996-2006.

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.