Hospitalist schedules promoting continuity of care may result in lower 30-day inpatient mortality rates, lower readmission rates, higher rates of discharge directly to the home, and lower 30-day post-discharge costs compared with discontinuous hospitalist schedules, study results published in JAMA Internal Medicine suggest.
The study was a retrospective analysis of data from Texas Medicare claims from January 1, 2014 to November 30, 2016. Researchers identified hospitalist physicians, analyzed and characterized their work schedules, and examined the association between hospitalist physician work schedules and patient outcomes.
A total of 114,777 hospital admissions with a 3- to 6-day length of stay were identified using the claims data. Only patients who received all general medical care from hospitalists were assessed. In total, patients and hospitalists from 229 hospitals in Texas were included in the study. The primary outcome was mortality within a 30-day period following discharge. Additional outcomes included discharge location, rate of 30-day readmission, and Medicare costs within a 30 days of discharge.
In the study cohort, mean age was 79.9±8.3 years and 61% of patients were women. In the lowest quartile of schedule continuity, hospitalists spent approximately 0% to 30% of their total working days providing care as part of a block of ≥7 consecutive days. This was compared with the highest quartile of schedule continuity in which hospitalists spent 67% to 100% of total working days providing care as part of a block of ≥7 consecutive days.
Patients cared for by hospitalists in the highest quartile of schedule continuity had a significantly lower 30-day mortality rate following discharge compared with patients in the lowest quartile of schedule continuity (6.47% vs 7.23%, respectively; adjusted odds ratio [aOR], 0.88; 95s CI, 0.81-0.95). In addition, patients in the highest quartile had lower readmission rates (aOR, 0.94; 95% CI, 0.90-0.99), higher rates of discharge directly home (aOR, 1.08; 95% CI, 1.03-1.13), and $223 lower 30-day post-discharge costs (95% CI, −$441 to −$7) compared with patients in the lowest quartile.
Study limitations included its retrospective and observational nature, which may have introduced selection bias.
The investigators concluded that their “findings should be considered in the design of hospitalist schedules.”
Goodwin JS, Li S, Kuo YF. Association of the work schedules of hospitalists with patient outcomes of hospitalization [published online November 25, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.5193