TY - JOUR
T1 - Association of communication between hospital-based physicians and primary care providers with patient outcomes
AU - Bell, Chaim M.
AU - Schnipper, Jeffrey L.
AU - Auerbach, Andrew D.
AU - Kaboli, Peter J.
AU - Wetterneck, Tosha B.
AU - Gonzales, David V.
AU - Arora, Vineet M.
AU - Zhang, James X.
AU - Meltzer, David O.
N1 - Funding Information:
Acknowledgements: The work reported here was supported by the Agency for Healthcare Quality (R01 HS 10597, A Multi-center Trial of Academic Hospitalists, PI: David Meltzer, MD, PhD). Dr. Bell is the recipient of a New Investigator Award from the Canadian Institutes of Health Research Institute of Aging. Dr. Kaboli is supported by a Research Career Development Award from the Health Services Research and Development Service, Department of Veterans Affairs (RCD 03-033-1). Dr. Schnipper is supported by a Mentored Clinical Scientist Award (HL072806) from the National Heart, Lung and Blood Institute, National Institutes of Health. Dr. Wetterneck was supported by a Mentored Clinical Research Scholars Award from the National Center for Research Resources, National Institutes of Health (RR01764-01), and is currently funded on a Mentored Clinical Scientist Development Award from AHRQ K08 HS17014-02. Dr. Arora is supported by the Hartford Geriatrics Health Outcomes Research Scholars Award and a CTSA K12 Scholars Award (KL2RR025000) from the National Center for Research Resources. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, National Center for Research Resources, or the National Institutes of Health. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. The corresponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
PY - 2009/3
Y1 - 2009/3
N2 - Background: Patients admitted to general medicine inpatient services are increasingly cared for by hospital-based physicians rather than their primary care providers (PCPs). This separation of hospital and ambulatory care may result in important care discontinuities after discharge. We sought to determine whether communication between hospital-based physicians and PCPs influences patient outcomes. METHODS: We approached consecutive patients admitted to general medicine services at six US academic centers from July 2001 to June 2003. A random sample of the PCPs for consented patients was contacted 2 weeks after patient discharge and surveyed about communication with the hospital medical team. Responses were linked with the 30-day composite patient outcomes of mortality, hospital readmission, and emergency department (ED) visits obtained through follow-up telephone survey and National Death Index search. We used hierarchical multi-variable logistic regression to model whether communication with the patient's PCP was associated with the 30-day composite outcome. RESULTS: A total of 1,772 PCPs for 2,336 patients were surveyed with 908 PCPs responses and complete patient follow-up available for 1,078 patients. The PCPs for 834 patients (77%) were aware that their patient had been admitted to the hospital. Of these, direct communication between PCPs and inpatient physicians took place for 194 patients (23%), and a discharge summary was available within 2 weeks of discharge for 347 patients (42%). Within 30 days of discharge, 233 (22%) patients died, were readmitted to the hospital, or visited an ED. In adjusted analyses, no relationship was seen between the composite outcome and direct physician communication (adjusted odds ratio 0.87, 95% confidence interval 0.56 - 1.34), the presence of a discharge summary (0.84, 95% CI 0.57-1.22), or PCP awareness of the index hospitalization (1.08, 95% CI 0.73-1.59). CONCLUSION: Analysis of communication between PCPs and inpatient medical teams revealed much room for improvement. Although communication during handoffs of care is important, we were not able to find a relationship between several aspects of communication and associated adverse clinical outcomes in this multi-center patient sample.
AB - Background: Patients admitted to general medicine inpatient services are increasingly cared for by hospital-based physicians rather than their primary care providers (PCPs). This separation of hospital and ambulatory care may result in important care discontinuities after discharge. We sought to determine whether communication between hospital-based physicians and PCPs influences patient outcomes. METHODS: We approached consecutive patients admitted to general medicine services at six US academic centers from July 2001 to June 2003. A random sample of the PCPs for consented patients was contacted 2 weeks after patient discharge and surveyed about communication with the hospital medical team. Responses were linked with the 30-day composite patient outcomes of mortality, hospital readmission, and emergency department (ED) visits obtained through follow-up telephone survey and National Death Index search. We used hierarchical multi-variable logistic regression to model whether communication with the patient's PCP was associated with the 30-day composite outcome. RESULTS: A total of 1,772 PCPs for 2,336 patients were surveyed with 908 PCPs responses and complete patient follow-up available for 1,078 patients. The PCPs for 834 patients (77%) were aware that their patient had been admitted to the hospital. Of these, direct communication between PCPs and inpatient physicians took place for 194 patients (23%), and a discharge summary was available within 2 weeks of discharge for 347 patients (42%). Within 30 days of discharge, 233 (22%) patients died, were readmitted to the hospital, or visited an ED. In adjusted analyses, no relationship was seen between the composite outcome and direct physician communication (adjusted odds ratio 0.87, 95% confidence interval 0.56 - 1.34), the presence of a discharge summary (0.84, 95% CI 0.57-1.22), or PCP awareness of the index hospitalization (1.08, 95% CI 0.73-1.59). CONCLUSION: Analysis of communication between PCPs and inpatient medical teams revealed much room for improvement. Although communication during handoffs of care is important, we were not able to find a relationship between several aspects of communication and associated adverse clinical outcomes in this multi-center patient sample.
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U2 - 10.1007/s11606-008-0882-8
DO - 10.1007/s11606-008-0882-8
M3 - Article
C2 - 19101774
AN - SCOPUS:60449112151
VL - 24
SP - 381
EP - 386
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 3
ER -