Turner Jonathan, Hansen Luke, Hinami Keiki, Christensen Nicholas, Peng Jie, Lee Jungwha, Williams Mark V, O'Leary Kevin J
Systems Engineering, University Health Care System, 1350 Walton Way, Augusta, GA, 30901, USA,
J Gen Intern Med. 2014 Jul;29(7):1004-8. doi: 10.1007/s11606-013-2754-0. Epub 2014 Jan 17.
Achieving patient-physician continuity is difficult in the inpatient setting, where care must be provided continuously. Little is known about the impact of hospital physician discontinuity on outcomes.
To determine the association between hospital physician continuity and percentage change in median cost of hospitalization, 30-day readmission, and patient satisfaction with physician communication.
Retrospective observational study using various multivariable models to adjust for patient characteristics.
Patients admitted to a non-teaching hospitalist service in a large, academic, urban hospital between 6 July 2008 and 31 December 2011.
We used two measures of continuity: the Number of Physicians Index (NPI), and the Usual Provider of Continuity (UPC) index. The NPI is the total number of unique physicians caring for a patient, while the UPC is calculated as the largest number of patient encounters with a single physician, divided by the total number of encounters. Outcome measures were percentage change in median cost of hospitalization, 30-day readmissions, and top box responses to satisfaction with physician communication.
Our analyses included data from 18,375 hospitalizations. Lower continuity was associated with modest increases in costs (range 0.9-12.6 % of median), with three of the four models used achieving statistical significance. Lower continuity was associated with lower odds of readmission (OR = 0.95-0.98 across models), although only one of the models achieved statistical significance. Satisfaction with physician communication was lower, with less continuity across all models, but results were not statistically significant.
Hospital physician discontinuity appears to be associated with modestly increased hospital costs. Hospital physicians may revise plans as they take over patient care responsibility from their colleagues.
在必须持续提供护理的住院环境中，实现患者与医生之间的连续性护理颇具难度。对于医院医生连续性中断对治疗结果的影响，我们知之甚少。
确定医院医生连续性与住院费用中位数的百分比变化、30天再入院率以及患者对医生沟通的满意度之间的关联。
采用多种多变量模型进行回顾性观察研究，以调整患者特征。
2008年7月6日至2011年12月31日期间入住一家大型学术性城市医院非教学医院医师服务部门的患者。
我们使用了两种连续性指标：医生数量指数（NPI）和连续性常规提供者（UPC）指数。NPI是为患者提供护理的不同医生的总数，而UPC的计算方法是患者与单一医生的最大接触次数除以总接触次数。结果指标为住院费用中位数的百分比变化、30天再入院率以及对医生沟通满意度的最高等级回答。
我们的分析纳入了18375例住院病例的数据。连续性较低与费用适度增加相关（范围为中位数的0.9%-12.6%），所使用的四个模型中有三个达到统计学显著性。连续性较低与再入院几率较低相关（各模型的OR = 0.95-0.98），尽管只有一个模型达到统计学显著性。对医生沟通的满意度较低，所有模型中的连续性均较低，但结果无统计学显著性。
医院医生连续性中断似乎与医院成本适度增加相关。医院医生在从同事手中接过患者护理责任时可能会修改治疗计划。
