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August 12, 2021JAMA Network OpenOpen Access

Association of Inpatient Continuity of Care With Complications and Length of Stay Among Hospitalized Medicare Enrollees

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Key result

Care from 2 hospitalists during the first 3 days of admission was associated with slightly greater odds of new drug toxic effects (OR 1.04; 95% CI 1.02-1.07) compared to a single hospitalist.

Why the study?

While continuity in primary care improves outcomes, less information exists regarding the association of inpatient continuity of care with hospital complications and length of stay.

Does receiving care from multiple hospitalists increase hospital complications and length of stay in hospitalized Medicare enrollees?

Population

617 680 Medicare medical admissions with length of stay longer than 4 days

Comparison

Number of different hospitalists (1 vs 2 vs 3) submitting charges during hospital days 1 to 3

Design

Retrospective cohort study

Authors

JGJames S. GoodwinSLShuang LiEHErin Hommel

Discussion

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Member takes

Overview

Multiple hospitalists early may slightly raise drug toxicity risk; leaves open whether continuity affects complications in observational data.

Study Design

Type

Cohort (n=617,680)

Structured PICO

Does receiving care from multiple hospitalists increase hospital complications and length of stay in hospitalized Medicare enrollees?

P
Population
617,680 Medicare medical admissions with a length of stay >4 days, evaluated for the association between the number of hospitalists and subsequent complications.
E
Exposure
Care provided by 2 or 3 different hospitalists during hospital days 1 to 3
C
Comparator
Care provided by the same (1) hospitalist during hospital days 1 to 3
O
Outcome
Overall length of stay and transfer to ICU or a new diagnosis of drug toxic effects on hospital day 4 or latersafety

Main Result

Odds Ratio: 1.04 (95% CI 1.02–1.07)

Receiving care from multiple hospitalists during the first 3 days of admission is not associated with worse length of stay or ICU transfers, though there is a marginal increase in drug toxic effects.

Cite This Study

Goodwin et al. (2021) conducted a cohort in Medical admissions (n=617,680). Care from multiple (2 or 3) different hospitalists vs. Care from a single hospitalist was evaluated on Overall length of stay and transfer to ICU or a new diagnosis of drug toxic effects on hospital day 4 or later (OR 1.04, 95% CI 1.02-1.07). Care from 2 hospitalists during the first 3 days of admission was associated with slightly greater odds of new drug toxic effects (OR 1.04; 95% CI 1.02-1.07) compared to a single hospitalist.

synapsesocial.com/papers/6a5e65b5c697a92aca92adf6https://doi.org/10.1001/jamanetworkopen.2021.20622
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Assessment of Care Handoffs Among Hospitalist Physicians and 30-Day Mortality in Hospitalized Medicare Beneficiaries2021 · 14 citations
  2. 2The effect of hospitalist discontinuity on adverse events2014 · 18 citations
  3. 3Continuity of Care and the Risk of Preventable Hospitalization in Older Adults2013 · 351 citations
  4. 4Primary care: America's health in a new era1997 · 819 citations