Melzer S M, Grossman D C, Rivara F P
Department of Pediatrics, Children's Hospital and Medical Center, Seattle, WA 98105-0371, USA.
Pediatrics. 1996 Jan;97(1):65-70.
To determine the frequency with which pediatricians and family physicians in Washington State serve as attending physicians for pediatric inpatients.
Retrospective review of statewide hospital discharge data.
Attending physicians for all patients younger than 18 years of age with nonsurgical diagnoses discharged from civilian hospitals in Washington State during 1989 and 1990.
Using medical rosters, the self-identified specialty of the attending physician was determined for 93% (n = 181,581) of discharges. Pediatricians and family physicians were listed as attending for 61% and 28%, respectively, of all eligible patients. Statewide, 97% (n = 555) of all pediatricians and 86% (n = 939) of all family physicians served as attending physicians for at least one inpatient, including healthy newborns, during the 2-year study period. The median annual number of discharges per physician was 78 for pediatricians and 14.5 for family physicians. Excluding healthy newborns, the median annual number of discharges was 25 for pediatricians and 3 for family physicians. Five percent of the physician attending group provided inpatient care for 50% of all children hospitalized with diagnoses other than healthy newborn; 50% of attending physicians cared for 95% of the patients. In rural hospitals, where family physicians served as attending physicians for 44% of pediatric inpatients, children were 3.3 times more likely to receive their care from family physicians than those hospitalized in urban centers.
Most pediatricians and family physicians serve as inpatient attending physicians for hospitalized children only infrequently. These findings question whether the emphasis on inpatient care in many pediatric and family medicine training programs remains an appropriate goal.
确定华盛顿州的儿科医生和家庭医生担任儿科住院患者主治医生的频率。
对全州医院出院数据进行回顾性审查。
1989年和1990年期间从华盛顿州民用医院出院的所有18岁以下非手术诊断患者的主治医生。
通过医学名册，确定了93%（n = 181,581）出院患者主治医生的自我认定专业。在所有符合条件的患者中，分别有61%和28%的患者列出儿科医生和家庭医生为主治医生。在全州范围内，在为期2年的研究期间，97%（n = 555）的儿科医生和86%（n = 939）的家庭医生至少担任过一名住院患者（包括健康新生儿）的主治医生。每位医生每年出院患者的中位数，儿科医生为78例，家庭医生为14.5例。排除健康新生儿后，儿科医生每年出院患者的中位数为25例，家庭医生为3例。5%的主治医生小组为50%的非健康新生儿诊断住院儿童提供住院治疗；50%的主治医生照顾了95%的患者。在农村医院，家庭医生担任44%儿科住院患者的主治医生，农村住院儿童接受家庭医生治疗的可能性是城市中心住院儿童的3.3倍。
大多数儿科医生和家庭医生很少担任住院儿童的住院主治医生。这些发现质疑了许多儿科和家庭医学培训项目中对住院治疗的重视是否仍然是一个合适的目标。
