The impact of fragmentation of hospitalist care on length of stay.
BACKGROUND
Different hospitalist staffing models provide different levels of inpatient continuity of care, which may impact length of stay (LOS).


OBJECTIVE
To determine if fragmentation of care (FOC) by hospitalist physicians is associated with LOS.


METHODS
Concurrent control study.


METHODS
Hospitalist practices managed by IPC The Hospitalist Company.


METHODS
A total of 10,977 patients admitted for diagnosis-related group (DRG) of 89 pneumonia with complications or comorbidities (PNA) or a DRG of 127 heart failure and shock (HF) between December 2006 and November 2007.


METHODS
FOC was defined as the percentage of care given by hospitalists other than the hospitalist who saw the patient the majority of the stay. Negative binomial regression was performed on DRG 89 and DRG 127 patients with LOS as the dependent variable. We adjusted for gender, age, severity of illness (SOI) scores, risk of mortality (ROM) scores, and number of secondary diagnoses, and admission day of the week.


RESULTS
A 10% increase in fragmentation was associated with an increase of 0.39 days (P < 0.0001) in the LOS for pneumonia, and an increase of 0.30 days (P < 0.0001) in LOS for heart failure.


CONCLUSIONS
As FOC increased for pneumonia and heart failure, the LOS increased significantly. Methods to reduce fragmentation should be explored, while more research is needed to identify the source of the relationship between FOC and LOS.
Epstein
Kenneth
K
IPC-The Hospitalist Company, North Hollywood, California, USA. kepstein@hei-med
Juarez
Esther
E
Epstein
Anne
A
Loya
Kathy
K
Singer
Adam
A
D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology; D020445:Hospitalists / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology; D012044:Regression Analysis; D012720:Severity of Illness Index; D012769:Shock / Q000175:diagnosis / Q000453:epidemiology