Park Jeongyoung, Jones Karen
Center for Workforce Studies, Association of American Medical Colleges, 655 K Street NW Suite 100, Washington, DC, 20001-2399, USA,
J Gen Intern Med. 2015 May;30(5):572-81. doi: 10.1007/s11606-014-3007-6.
Growth in the care of hospitalized patients by hospitalists has the potential to increase the productivity of office-based primary care physicians (PCPs) by allowing them to focus on outpatient practice.
Our aim was to examine the association between utilization of hospitalists and the productivity of office-based PCPs.
DESIGN/PARTICIPANTS: The cross-sectional study was conducted using the 2008 Health Tracking Physician Survey Restricted Use File linked to the Area Resource File. We analyzed a total of 1,158 office-based PCPs representing a weighted total of 97,355 physicians.
Utilization of hospitalists was defined as the percentage of a PCP's hospitalized patients treated by a hospitalist. The measures of PCPs' productivity were: (1) number of hospital visits per week, (2) number of office and outpatient clinic visits per week, and (3) direct patient care time per visit.
We found that the use of hospitalists was significantly associated with a decreased number of hospital visits. The use of hospitalists was also associated with an increased number of office visits, but this was only significant for high users. Physicians who used hospitalists for more than three-quarters of their hospitalized patients had an extra 8.8 office visits per week on average (p = 0.05), which was equivalent to a 10 % increase in productivity over the predicted mean of 87 visits for physicians who did not use hospitalists. We did not find any significant differences in direct patient care time per visit.
Our study demonstrates that the increase in productivity for the one-third of PCPs who use hospitalists extensively may not be sufficient to offset the current loss of PCP workforce. However, our findings provide cautious optimism that if more PCPs effectively and efficiently used hospitalists, this could help mitigate a PCP shortage and improve access to primary care services.
医院医生对住院患者护理的增加，有可能通过让门诊初级保健医生（PCP）专注于门诊实践，从而提高其工作效率。
我们的目的是研究医院医生的使用与门诊PCP工作效率之间的关联。
设计/参与者：横断面研究使用了与区域资源文件相关联的2008年健康跟踪医生调查受限使用文件。我们分析了总共1158名门诊PCP，加权总数代表97355名医生。
医院医生的使用定义为PCP的住院患者中由医院医生治疗的百分比。PCP工作效率的测量指标为：（1）每周医院就诊次数；（2）每周办公室和门诊就诊次数；（3）每次就诊的直接患者护理时间。
我们发现，医院医生的使用与医院就诊次数的减少显著相关。医院医生的使用还与办公室就诊次数的增加相关，但这仅对高使用者显著。对于超过四分之三的住院患者使用医院医生的医生，平均每周额外有8.8次办公室就诊（p = 0.05），这相当于未使用医院医生的医生预测平均就诊次数87次的生产率提高了10%。我们未发现每次就诊的直接患者护理时间有任何显著差异。
我们的研究表明，对于广泛使用医院医生的三分之一PCP而言，工作效率的提高可能不足以抵消目前PCP劳动力的损失。然而，我们的研究结果提供了谨慎的乐观态度，即如果更多PCP有效且高效地使用医院医生，这有助于缓解PCP短缺并改善初级保健服务的可及性。
