利用临床实践数据定义住院医师：安大略省医师的系统层面试点研究

Defining hospitalist physicians using clinical practice data: a systems-level pilot study of Ontario physicians.

作者信息

White Heather L, Stukel Thérèse A, Wodchis Walter P, Glazier Richard H

机构信息

Heather L. White, MSc, is a PhD candidate at the Institute of Health Policy, Management and Evaluation, University of Toronto, and a student at the Institute for Clinical Evaluative Sciences, Toronto, Ontario.

Thérèse A. Stukel, PhD, is a Senior Scientist at the Institute for Clinical Evaluative Sciences, Toronto, Ontario; an Adjunct Professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; and a Professor at the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.

出版信息

Open Med. 2013 Sep 17;7(3):e74-84. eCollection 2013.

PMID:25237402

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4161497/

Abstract

BACKGROUND

Hospitalists have become dominant providers of inpatient care in many North American hospitals. Despite the global growth of hospital medicine, no objective method has been proposed for defining the hospitalist discipline and delineating among inpatient practices on the basis of physicians' clinical volumes. We propose a functional method of identifying hospital-based physicians using aggregated measures of inpatient volume and apply this method to a retrospective, population-based cohort to describe the growth of the hospitalist movement, as well as the prevalence and practice characteristics of hospital-based generalists in one Canadian province.

METHODS

We used human resource databases and financial insurance claims to identify all active fee-for-service physicians working in Ontario, Canada, between fiscal year 1996/1997 and fiscal year 2010/2011. We constructed 3 measures of inpatient volume from the insurance claims to reflect the time that physicians spent delivering inpatient care in each fiscal year. We then examined how inpatient volumes have changed for Ontario physicians over time and described the prevalence of full-time and part-time hospital-based generalists working in acute care hospitals in fiscal year 2010/2011.

RESULTS

Our analyses showed a significant increase since fiscal year 2000/2001 in the number of high-volume hospital-based family physicians practising in Ontario (p < 0.001) and associated decreases in the numbers of high-volume internists and specialists (p = 0.03), where high volume was defined as ≥ 2000 inpatient services/ year. We estimated that 620 full-time and 520 part-time hospital-based physicians were working in Ontario hospitals in 2010/2011, accounting for 4.5% of the active physician workforce (n = 25 434). Hospital-based generalists, consisting of 207 family physicians and 130 general internists, were prevalent in all geographic regions and hospital types and collectively delivered 10% of all inpatient evaluation and care coordination for Ontario residents who had been admitted to hospital.

INTERPRETATION

These analyses confirmed a substantial increase in the prevalence of general hospitalists in Ontario from 1996 to 2011. Systems-level analyses of clinical practice data represent a practical and valid method for defining and identifying hospital-based physicians.

摘要

背景

在许多北美医院中，住院医师已成为住院治疗的主要提供者。尽管医院医学在全球范围内不断发展，但尚未提出一种客观的方法来界定住院医师学科，并根据医生的临床工作量区分住院治疗实践。我们提出了一种使用住院量汇总指标来识别医院医生的功能性方法，并将此方法应用于一项基于人群的回顾性队列研究，以描述住院医师运动的发展，以及加拿大一个省份医院通科医生的患病率和实践特征。

方法

我们使用人力资源数据库和金融保险理赔数据，识别出1996/1997财政年度至2010/2011财政年度期间在加拿大安大略省工作的所有按服务收费的在职医生。我们从保险理赔数据中构建了3个住院量指标，以反映医生在每个财政年度提供住院治疗的时间。然后，我们研究了安大略省医生的住院量随时间的变化情况，并描述了2010/2011财政年度在急症医院工作的全职和兼职医院通科医生的患病率。

结果

我们的分析表明，自2000/2001财政年度以来，安大略省从事大量住院治疗工作的家庭医生数量显著增加（p < 0.001），而从事大量住院治疗工作的内科医生和专科医生数量相应减少（p = 0.03），大量住院治疗工作定义为每年≥2000例住院服务。我们估计，2010/2011年有620名全职和520名兼职医院医生在安大略省医院工作，占在职医生总数（n = 25434）的4.5%。由207名家庭医生和130名普通内科医生组成的医院通科医生在所有地理区域和医院类型中都很普遍，他们共同为安大略省住院居民提供了10%的住院评估和护理协调服务。