Trends in inpatient continuity of care for a cohort of Medicare patients 1996-2006.

Abstract

BACKGROUND: Little is known about how changes in health care delivery, such as the use of hospitalists, have impacted inpatient continuity. OBJECTIVE: To examine the extent of inpatient discontinuity (ie, being seen by more than one generalist physician) during hospitalization for selected patients. DESIGN: Retrospective cohort. SETTING: 4,859 US hospitals. PATIENTS: Medicare fee-for-service beneficiaries hospitalized for chronic obstructive pulmonary disease (COPD), pneumonia, and congestive heart failure (CHF) from 1996 through 2006. MEASUREMENTS: We analyzed the proportion of Medicare beneficiaries who received care from 1, 2, or 3 or more generalist physicians during hospitalization. We also examined the factors associated with continuity during the hospitalization. RESULTS: Between 1996 and 2006, 64.3% of patients received care from 1, 26.9% from 2 and 8.8% from 3 or more generalist physicians during hospitalization. The percentage of patients who received care from one generalist physician declined from 70.7% in 1996 to 59.4% in 2006 (P < 0.001). In a multivariable analysis, continuity with one generalist physician decreased by 5.5% (95% CI, 5.3%-5.6%) per year between 1996 and 2006. Patients receiving all care from hospitalists saw fewer generalist physicians compared to those who received all care from a non-hospitalist or both. Older patients, females, non-Hispanic whites, those with higher socioeconomic status, and those with more comorbidities were more likely to receive care from multiple generalist physicians. LIMITATIONS: The results may not be generalizable to non-Medicare populations. CONCLUSIONS: Hospitalized patients are experiencing less continuity than 10 years ago. The hospitalist model of care does not appear to play a role in this discontinuity.