Solomon Sonja R, Gooding Holly C, Reyes Nieva Harry, Linder Jeffrey A
Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.
Harvard Medical School, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.
J Gen Intern Med. 2015 Nov;30(11):1611-7. doi: 10.1007/s11606-015-3305-7. Epub 2015 Apr 21.
The disruption in provider continuity caused by medical resident graduation may result in adverse patient outcomes.
Our aim was to investigate whether resident graduation was associated with increased acute care utilization by residents' primary care patients.
This was a retrospective cohort study of patients cared for by junior and senior residents finishing the academic year in 2010, 2011 and 2012.
We compared rates of clinic visits, emergency department (ED) visits, and hospitalizations between transitioning patients whose residents were graduating and non-transitioning patients whose residents were not graduating.
Our study population comprised 90 residents, 4018 unique patients, and 5988 resident-patient dyads that transitioned (n = 3136) or did not transition (n = 2852). For transitioning patients, the clinic visit rate per 100 patients in the 4 months before and after graduation was 129 and 102, respectively; for non-transitioning patients, the clinic visit rate was 119 and 94, respectively (difference-in-differences, +2 per 100 patients; p = 0.12). For transitioning patients, the ED visit rate per 100 patients before and after graduation was 29 and 26, respectively; for non-transitioning patients, the ED visit rate was 28 and 25, respectively (difference-in-differences, 0; p = 0.49). For transitioning patients, the hospitalization rate per 100 patients before and after graduation was 14 and 13, respectively; for non-transitioning patients, the hospitalization rate was 15 and 12, respectively (difference-in-differences, -2; p = 0.20). In multivariable modeling there was no increased risk for transitioning patients for clinic visits (adjusted rate ratio [aRR], 1.03; 95 % confidence interval [CI], 0.97 to 1.10), ED visits (aRR, 1.05; 95 % CI, 0.92 to 1.20), or hospitalizations (aRR, 1.04; 95 % CI, 0.83 to 1.31).
Acute care utilization by residents' patients did not increase or decrease after graduation. Acute care utilization was high before and after graduation. Interventions to decrease the need for acute care should be employed throughout the year.
住院医师毕业导致的医疗服务连续性中断可能会给患者带来不良后果。
我们旨在调查住院医师毕业是否与他们的初级保健患者急性护理利用率增加有关。
这是一项对2010年、2011年和2012年完成学年的初级和高级住院医师所照顾患者的回顾性队列研究。
我们比较了住院医师毕业的转诊患者与住院医师未毕业的非转诊患者之间的门诊就诊率、急诊科就诊率和住院率。
我们的研究人群包括90名住院医师、4018名独特患者以及5988对住院医师 - 患者组合，其中有3136对发生了转诊，2852对未发生转诊。对于转诊患者，毕业前后4个月每100名患者的门诊就诊率分别为129次和102次；对于非转诊患者，门诊就诊率分别为119次和94次（差异差值为每100名患者增加2次；p = 0.12）。对于转诊患者，毕业前后每100名患者的急诊科就诊率分别为29次和26次；对于非转诊患者，急诊科就诊率分别为28次和25次（差异差值为0；p = 0.49）。对于转诊患者，毕业前后每100名患者的住院率分别为14次和13次；对于非转诊患者，住院率分别为15次和12次（差异差值为 -2；p = 0.20）。在多变量模型中，转诊患者的门诊就诊（调整率比[aRR]，1.03；95%置信区间[CI]，0.97至1.10）、急诊科就诊（aRR，1.05；95% CI，0.92至1.20）或住院（aRR，1.04；95% CI，0.83至1.31）风险均未增加。
住院医师毕业之后，其患者的急性护理利用率并未增加或减少。毕业前后急性护理利用率都很高。全年都应采取干预措施以减少对急性护理的需求。
