In 1996 through 2006, 45.2% (95% CI: 45.1% – 45.3%, n=1,246,201) of hospitalized patients received care during hospitalization by a physician who had seen them at least once as an outpatient in the prior year, while 38.0%( 95% CI:37.9% – 38.1%, n=587,269) of hospitalized patients with an identified PCP received care from that PCP during hospitalization.
presents the percentage of the study sample from 1996–2006 seen during hospitalization by any physician they had seen as an outpatient in the prior year, or by their PCP, stratified by patient and hospital characteristics. Older patients, those with multiple comorbidities, those admitted through the emergency room, with medical (vs. surgical) diagnoses, living closer to the hospital, in smaller metropolitan areas or hospitalized in community hospitals were more likely to have continuity with any outpatient physician or with their PCP. There was also geographic variation in continuity of care, with the Rocky Mountain region having the lowest continuity.
presents the percentage of patients experiencing outpatient to inpatient continuity of care with any outpatient physician, or with their PCP, by year of hospitalization. Outpatient to inpatient continuity with any outpatient physician declined from 50.5% (95% CI: 50.3% – 50.7%, n=125,789) in 1996 to 39.8% (95% CI: 39.6%-40.0%, n=99,463) in 2006 (p<.001). Similarly, outpatient to inpatient continuity with a PCP declined from 44.3% (95% CI: 44.1% – 44.6%, n=58,046) in 1996 to 31.9% (31.6% – 32.1%, n=47,761) in 2006 (p<.001).
Percentage of pateints experiencing continuity with any outpatient physician or with their primary care physician (PCP) during hospitalization, 1996 through 2006.
presents the absolute declines in continuity of care from 1996 to 2006 by patient and hospital characteristics. Declines in outpatient to inpatient continuity with any outpatient physician were seen in all strata, with greater absolute declines seen in those admitted on the weekend, those with medical diagnoses, and those living in larger metropolitan areas. Declines varied markedly by geographic area, with the largest absolute declines seen in New England. Similar declines were seen in continuity with a PCP.
Percent of hospitalized patient experiencing continuity of care with any outpatient provider or thei PCP in 1996 and 2006, stratified by patient and hospital characteristics
presents the results of multilevel multivariable analyses of factors associated with outpatient to inpatient continuity with any outpatient physician who saw the patient at least once in the year prior to hospitalization. As shown in Model 1, the odds of hospitalized patients receiving care from any outpatient physician declined by 3.9% (95% CI: 3.8% – 4.0%) per year from 1996 to 2006. This was not substantially changed (4.4%, 95% CI: 4.3% – 4.4%) after adjusting for other relevant factors in Model 2. Other factors associated with continuity were higher socioeconomic status, higher comorbidity, medical (vs. surgical) DRG, admission on a weekday, smaller metropolitan area, and care in a non-teaching, non-profit or smaller sized hospital. There were also substantial variations by geographic region.
Multilevel multivariable analysis of odds of outpatient to inpatient continuity of care with any outpatient physician who saw the patient at least once in the year prior to hospitalization, 1996 to 2006.
In model 3 of we included all the variables in model 2 and introduced whether the patient was cared for by a hospitalist during hospitalization. Adding this variable did not substantially alter the odds of continuity associated with the other variables, with the exception of admission year. The decline was 4.4% per year in Model 2, and reduced to 2.8% per year (95% CI: 2.7%-2.9%) when care by a hospitalist was added in Model 3.
We assessed whether changes in continuity of care varied between academic vs. community hospitals by testing two, two-way interactions in Model 3 of : the interaction of admission year and hospital teaching status (major medical school affiliation vs. none) and the interaction of hospitalist and hospital teaching status. Both interactions were significant. The odds of experiencing continuity of care declined more rapidly at major teaching hospitals, 4.4% per year (95% CI: 4.2% – 4.5% ) than at community hospitals, 2.3% per year (95% CI: 2.2% – 2.4%; P<0.001). Also, care by a hospitalist was associated with a 65.4% (95% CI: 65.0% – 65.9%) reduction in odds of continuity of care at community hospitals vs. a 53.4% (95% CI: 52.5% – 54.4%) reduction in major teaching hospitals (P<0.001). We also performed the analyses in with the outcome of continuity with a PCP (data not shown). The results were similar to those presented for continuity with any outpatient physician.
Finally, we assessed the percentage of patients hospitalized in 2006 who were cared for in the hospital by any physician who had provided care for them in the prior two years, whether in an inpatient or outpatient setting. Using this definition, 47.7% of patients hospitalized in 2006 experienced continuity of care.