O'Leary Kevin J, Turner Jonathan, Christensen Nicholas, Ma Madeleine, Lee Jungwha, Williams Mark V, Hansen Luke O
Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Hosp Med. 2015 Mar;10(3):147-51. doi: 10.1002/jhm.2308. Epub 2014 Dec 19.
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.
To determine the association between hospital physician continuity and the incidence of adverse events (AEs).
Retrospective observational study using multivariable models to adjust for patient characteristics.
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.
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.
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.
由于需要持续提供医疗服务，在医院环境中实现患者与医生之间的连续性较为困难。医院医生连续性中断对患者安全的影响尚不清楚。
确定医院医生连续性与不良事件（AE）发生率之间的关联。
采用多变量模型进行回顾性观察研究，以调整患者特征。
2009年3月1日至2011年12月31日期间入住一家大型学术医院非教学医院医师服务部门的患者。
使用了两种连续性测量方法。医生数量指数（NPI）是为患者提供治疗的不同医院医师的总数。常规护理提供者（UPC）指数是与最常接触的医院医师接触的比例。结果指标是通过信息系统自动查询检测到并经两名医师研究人员确认的不良事件。
我们的分析包括474例住院病例的数据。在未调整的模型中，NPI每增加1个单位（即连续性降低），与发生1次或更多次不良事件的发生率显著相关（比值比=1.75；P<0.001）。然而，UPC与不良事件发生率无关。在所有调整后的模型中，NPI和UPC均与不良事件发生率无显著关联。不同模型中，连续性中断对不良事件的影响方向也不一致。
医院医师的连续性似乎与不良事件的发生率无关。由于医院护理由临床医生团队提供，未来的研究应评估团队复杂性和动态性对患者结局的影响。
