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The Influence of Inpatient Physician Continuity on Hospital Discharge

  • Carl van WalravenEmail author
Original Research

Abstract

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.

KEY WORDS

hospital discharge general internal medicine continuity of care generalized estimating equations 

Notes

Funding Information

This study was supported by the Department of Medicine, University of Ottawa.

Compliance with Ethical Standards

Conflict of Interest

The author declares no conflicts of interest.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Medicine and Epidemiology & Community Medicine, University of Ottawa, ICES uOttawaOttawa Hospital Research InstituteOttawaCanada

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