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Association of communication between hospital-based physicians and primary care providers with patient outcomes.
J Gen Intern Med 2009; 24(3):381-6JG

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.

Authors+Show Affiliations

Department of Medicine, University of Toronto, Toronto, ON, Canada. bellc@smh.toronto.on.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

19101774

Citation

Bell, Chaim M., et al. "Association of Communication Between Hospital-based Physicians and Primary Care Providers With Patient Outcomes." Journal of General Internal Medicine, vol. 24, no. 3, 2009, pp. 381-6.
Bell CM, Schnipper JL, Auerbach AD, et al. Association of communication between hospital-based physicians and primary care providers with patient outcomes. J Gen Intern Med. 2009;24(3):381-6.
Bell, C. M., Schnipper, J. L., Auerbach, A. D., Kaboli, P. J., Wetterneck, T. B., Gonzales, D. V., ... Meltzer, D. O. (2009). Association of communication between hospital-based physicians and primary care providers with patient outcomes. Journal of General Internal Medicine, 24(3), pp. 381-6. doi:10.1007/s11606-008-0882-8.
Bell CM, et al. Association of Communication Between Hospital-based Physicians and Primary Care Providers With Patient Outcomes. J Gen Intern Med. 2009;24(3):381-6. PubMed PMID: 19101774.
* Article titles in AMA citation format should be in sentence-case
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, Y1 - 2008/12/20/ PY - 2008/03/18/received PY - 2008/11/10/accepted PY - 2008/10/27/revised PY - 2008/12/23/entrez PY - 2008/12/23/pubmed PY - 2009/5/29/medline SP - 381 EP - 6 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 24 IS - 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. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/19101774/Association_of_communication_between_hospital_based_physicians_and_primary_care_providers_with_patient_outcomes_ L2 - https://dx.doi.org/10.1007/s11606-008-0882-8 DB - PRIME DP - Unbound Medicine ER -