Different hospitalist staffing models provide different levels of inpatient continuity of care. There has been increasing discussion about the impact of discontinuity of care on length of stay (LOS) and other utilization and quality metrics. The purpose of this study was to explore the impact of continuity of hospitalist staffing patterns on acute care length of stay and on clinical problems postdischarge.
Using IPC's billing and clinical database, we analyzed all inpatient admissions for DRG 89 (pneumonia with complications or comorbidities) or DRG 127 (heart failure and shock) between December 2006 and November 2007. We defined fragmentation of care as the percentage of care given by hospitalists other than the hospitalist who saw the patient the majority of the stay (defined as the primary hospitalist). Ordinary least‐squares (OLS) regressions were performed separately on DRG 89 and DRG 127 patients with LOS as the dependent variable. For a subset of patients, we had data from surveys performed 48‐72 hours postdischarge by our call center. Logistic regressions were performed on the combined diagnoses group with reported problems requiring nurse follow‐up as the dependent variables. In all models, we controlled for sex, age, severity of illness score, risk of mortality score, and number of secondary diagnoses.
We analyzed 10,233 patients with LOS < 14 days. The mean LOS was 5.81 days (SD 3.26 days) for DRG 89 (n = 1724) and 4.69 days (SD 2.94 days) for DRG 127 (n = 8509). For every 10% increase in percent fragmentation, the LOS went up by 0.45 days for DRG 89, and by 0.38 days for DRG 127 (both P < .0001). The percentage of patients having difficulty with receiving postdischarge follow‐up appointments or home health care visits was 4.0% (n = 2445, combined DRGs). Likewise, 6.4% had difficulties with their medications, and 8.4% had new or worsening symptoms. The only postdischarge complication that approached statistical significance for changes with fragmentation of care was the follow‐up appointment group, where for every 10% increase in fragmentation, the absolute rate of having difficulty with these access‐to‐care issues went up by 0.9% (a 24.8% increase, P = .07). For medication problems or worsening symptoms post‐discharge, there was no change with increasing fragmentation of care.
As fragmentation of inpatient care increased for pneumonia and heart failure, the LOS increased significantly. There was also an increase in patients having issues with receiving their outpatient follow‐up appointment or home health care visit that approached statistical significance. These findings suggest more work is needed to determine the ideal hospitalist staffing method. Further studies on the impact of fragmentation of hospitalist care are warranted.
K. Epstein, IPC — The Hospitalist Co., employment; E. Juarez, IPC — The Hospitalist Co., employment; A. Epstein, IPC — The Hospitalist Co., research funding; K. Loya, IPC — The Hospitalist Co., employment; A. Singer, IPC — The Hospitalist Co., employment.
To cite this abstract:Epstein K, Juarez E, Epstein A, Loya K, Singer A. Impact of Fragmentation of Hospitalist Care on Length of Stay and Postdischarge Issues. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 20. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/impact-of-fragmentation-of-hospitalist-care-on-length-of-stay-and-postdischarge-issues/. Accessed December 7, 2019.