Association of Communication Between Hospital-based Physicians and Primary Care Providers with Patient Outcomes |
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| Authors: | Chaim M. Bell Jeffrey L. Schnipper Andrew D. Auerbach Peter J. Kaboli Tosha B. Wetterneck David V. Gonzales Vineet M. Arora James X. Zhang David O. Meltzer |
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| Affiliation: | (1) Departments of Medicine and Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada;(2) St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada;(3) Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada;(4) BWF Hospitalist Service and Division of General Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA;(5) University of California-San Francisco, San Francisco, CA, USA;(6) Iowa City VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, IA, USA;(7) University of Wisconsin School of Medicine and Public Health, Madison, WI, USA;(8) University of New Mexico, Albuquerque, NM, USA;(9) University of Chicago, Chicago, IL, USA |
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| Abstract: | ![]()
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. This paper was presented at the Society for General Internal Medicine Annual Meeting in April 2006. |
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| Keywords: | hospitalist care continuity of care physician communication |
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