Journal article
Association of Communication Between Hospital-based Physicians and Primary Care Providers with Patient Outcomes
Journal of general internal medicine : JGIM, Vol.24(3), pp.381-386
03/2009
DOI: 10.1007/s11606-008-0882-8
PMCID: PMC2642573
PMID: 19101774
Abstract
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.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.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).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.
Details
- Title: Subtitle
- Association of Communication Between Hospital-based Physicians and Primary Care Providers with Patient Outcomes
- Creators
- Chaim Bell - Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto CanadaJeffrey Schnipper - BWF Hospitalist Service and Division of General Medicine Brigham and Women’s Hospital and Harvard Medical School Boston MA USAAndrew Auerbach - University of California-San Francisco San Francisco CA USAPeter Kaboli - Iowa City VA Medical Center and the University of Iowa Carver College of Medicine Iowa City IA USATosha Wetterneck - University of Wisconsin School of Medicine and Public Health Madison WI USADavid Gonzales - University of New Mexico Albuquerque NM USAVineet Arora - University of Chicago Chicago IL USAJames Zhang - University of Chicago Chicago IL USADavid Meltzer - University of Chicago Chicago IL USA
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.24(3), pp.381-386
- DOI
- 10.1007/s11606-008-0882-8
- PMID
- 19101774
- PMCID
- PMC2642573
- NLM abbreviation
- J Gen Intern Med
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Publisher
- Springer-Verlag
- Language
- English
- Date published
- 03/2009
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9984094326102771
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