Does continual care equal better patient outcomes?
The results of a new observational study suggest that patients treated by hospitalists who have high work schedule continuity have significantly better outcomes, including lower post-discharge 30-day mortality rates.
Researchers from The University of Texas Medical Branch at Galveston (TX, USA) have investigated the association between hospitalists work schedules that allow for continuity of inpatient care and the health outcomes of patients. The results of the study suggest that patients treated at hospitals where continual inpatient care is available have significantly better outcomes, including lower post-discharge 30-day mortality rates, lower readmission rates and lower post-discharge health costs.
Discontinuous working schedules of hospitalists – such as working 24 hours on followed by 48 hours off – can mean that several hospitalists provide care for a single patient during their hospital stay. In this study, researchers investigated whether such care discontinuity during hospitalization may be associated with poorer outcomes for patients.
Investigators analyzed claims data of 114,777 Medicare beneficiaries who were hospitalized from 2014–2016 and had inpatient stays of 3–6 days in duration. All study participants received general medical across 229 Texas hospitals.
For each admission, researchers determined hospitalists' schedule continuity by calculating the percentage of hospitalists’ total working days each year that were performed in blocks of seven consecutive days in length, or more.
Researchers classified the admissions according to the schedule continuity of care-providing hospitalists; hospitalists in the lowest quartile for schedule continuity worked 0–30% of their total working days as part of a block of seven consecutive days, or more. By contrast, this percentage was 67–100% for hospitalists in the highest quartile of schedule continuity.
Key study findings include that patients who received care from hospitalists in the highest quartile of schedule continuity had statistically significantly lower post-discharge 30-day mortality rates, compared with individuals treated by hospitalists in the lowest quartile of schedule continuity.
Hospital readmissions rates and post-discharge health costs were also significantly lower for individuals who received care from high-continuity hospitalists compared with lower continuity.
In the study, the authors concluded: “Hospitalist schedules vary widely. Admitted patients receiving care from hospitalists with schedules that promote inpatient continuity of care may experience better outcomes of hospitalization.”
Goodwin JS, Li S, Kuo Y-F. Association of the work schedules of hospitalists with patient outcomes of hospitalization. JAMA Intern Med. doi:org/10.1001/jamainternmed.2019.5193 (2019) (Epub ahead of print)