Patients treated by hospitalists during their first year of practice are more likely to experience 30-day and in-hospital mortality compared with patients treated by more experienced hospitalists, according to a study published in JAMA Internal Medicine.
Investigators analyzed a 5% sample of Medicare beneficiaries to determine the association between mortality and hospitalists’ years of practice experience. The researchers created a cross-sectional cohort that included 21,612 hospitalists, with a 5-year look-back period to assess the participants’ years of prior experience. Another longitudinal cohort was created that consisted of 3860 hospitalists in their first year of practice who continued to practice hospital medicine for another 4 years. Approximately 25% of the 21,612 hospitalists in the cross-sectional cohort had ≤1 year of practice experience and more than half (54%) had ≥4 years’ experience.
The observed 30-day mortality in patients treated by hospitalists in their first year of practice was 10.50% vs 9.97% for second-year hospitalists. Compared with hospitalists in their first year, the odds for 30-day mortality in patients treated by hospitalists in their second year were 0.90 (95% CI, 0.84-0.96). In addition, the odds for in-hospital mortality were greater in patients treated by first-year vs second-year hospitalists (3.33% vs 2.96%, respectively; odds ratio, 0.84; 95% CI, 0.75-0.95). Once hospitalists moved into their second year, the odds for 30-day and hospital mortality became more consistent and did not vary significantly.
One limitation associated with this study is its observational nature, potentially subjecting the data to selection bias. Since this patient population was restricted to older Medicare beneficiaries, it is also possible that the findings may not be generalizable to other patient groups.
The involvement of “hospitalist faculty in residency training and [the] creation of hospitalist tracks in residency or hospitalist fellowship programs may prepare individuals better for the challenges early in their hospitalist career” and help mitigate the poor mortality outcomes in patients treated by first-year hospitalists.
Goodwin JS, Salameh H, Zhou J, et al. Association of hospitalist years of experience with mortality in the hospitalized Medicare population [published online December 26, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.7049