The independent association of provider and information continuity on outcomes after hospital discharge: implications for hospitalists.
BACKGROUND
Since hospitalist physicians do not frequently see patients in follow-up after discharge from the hospital, patient continuity of care will decrease. To determine how this influenced patient outcomes, we examined the independent association of several physician continuity and information continuity measures on death or urgent readmission after discharge from hospital.


METHODS
Multicenter, prospective cohort study of patients discharged to the community after elective or emergency hospitalization. We measured three physician continuity scores (preadmission; hospital; and postdischarge) and two information continuity scores (discharge summary; postdischarge visit information) as time-dependent covariates. Continuity scores ranged from 0 (perfect discontinuity) to 1 (perfect continuity). The primary outcomes were time to all-cause death or urgent readmission.


RESULTS
A total of 3876 people were followed for a median of 175 days. Death rate was 2.6 events per 100 patient-years observation (pys) (95% confidence interval [CI], 2.0-3.4) and urgent readmission rate was 19.6 events per 100 pys (95% CI, 15.9-24.3). After adjusting for important covariates and other continuity scores, increased preadmission physician continuity was independently associated with a decreased risk of urgent readmission (adjusted hazard ratio 0.94 [95% CI, 0.91-0.98] for each absolute increase in continuity of 0.1). Other continuity measures-including hospital physician continuity-were not associated with either outcome.


CONCLUSIONS
After discharge from the hospital, increased continuity with physicians who routinely treated the patient prior to the admission was significantly and independently associated with a decreased risk of urgent readmission. These data suggest that continuity with the hospital physician after discharge did not independently influence the risk of patient death or urgent readmission.
van Walraven
Carl
C
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. carlv@ohri.ca
Taljaard
Monica
M
Etchells
Edward
E
Bell
Chaim M
CM
Stiell
Ian G
IG
Zarnke
Kelly
K
Forster
Alan J
AJ
D000368:Aged; D000416:Alberta; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006305:Health Status Indicators; D020445:Hospitalists / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome