The Influence of Inpatient Physician Continuity on Hospital Discharge

• Published in: Journal of general internal medicine : JGIM 2019-09, Vol.34 (9), p.1709-1714
• Main Author: van Walraven, Carl
• Format: Article
• Language: English
• Subjects: Ambulatory care; Calibration; Continuity of care; Emergency medical care; Hospitalization; Internal Medicine; Laboratories; Length of stay; Mathematical models; Medical personnel; Medicine; Medicine & Public Health; Original Research; Patients; Physicians; Probabilistic methods; Probability; Resource utilization; Statistical analysis; Teaching hospitals
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-019-05031-5

Background Inpatient attending physicians may change during a patient’s hospital stay. This study measured the association of attending physician continuity and discharge probability. Methods All patients admitted to general medicine service at a tertiary care teaching hospital in 2015 were included. Attending inpatient physician continuity was measured as the consecutive number of days each patient was treated by the same staff-person. Generalized estimating equation methods were used to model the adjusted association of attending inpatient physician continuity with daily discharge probability. Results 6301 admissions involving 41 internists, 5134 patients, and 38,242 patient-days were studied. The final model had moderate discrimination (c-statistic = 0.70) but excellent calibration (Hosmer-Lemeshow statistic 11.5, 18 df, p value 0.89). Daily discharge probability decreased significantly with greater severity of illness, higher patient death risk, and longer length of stay, on admission day, for elective admissions, and on the weekend. Discharge likelihood increased significantly with attending inpatient physician continuity; daily discharge probability increased for the average patient from 15.3 to 20.9% when the consecutive number of days the patient was treated by the same attending inpatient physician increased from 1 to 7 days. Conclusions Inpatient attending physician continuity is significantly associated with the likelihood of patient discharge. This finding could be considered if resource utilization is a factor when scheduling attending inpatient physician coverage.