title: The impact of hospitalist discontinuity on hospital cost, readmissions, and patient satisfaction.
abstract: BACKGROUND
  Achieving patient-physician continuity is difficult in the inpatient setting, where care must be provided continuously. Little is known about the impact of hospital physician discontinuity on outcomes.
  
  
  OBJECTIVE
  To determine the association between hospital physician continuity and percentage change in median cost of hospitalization, 30-day readmission, and patient satisfaction with physician communication.
  
  
  METHODS
  Retrospective observational study using various multivariable models to adjust for patient characteristics.
  
  
  METHODS
  Patients admitted to a non-teaching hospitalist service in a large, academic, urban hospital between 6 July 2008 and 31 December 2011.
  
  
  METHODS
  We used two measures of continuity: the Number of Physicians Index (NPI), and the Usual Provider of Continuity (UPC) index. The NPI is the total number of unique physicians caring for a patient, while the UPC is calculated as the largest number of patient encounters with a single physician, divided by the total number of encounters. Outcome measures were percentage change in median cost of hospitalization, 30-day readmissions, and top box responses to satisfaction with physician communication.
  
  
  RESULTS
  Our analyses included data from 18,375 hospitalizations. Lower continuity was associated with modest increases in costs (range 0.9-12.6 % of median), with three of the four models used achieving statistical significance. Lower continuity was associated with lower odds of readmission (OR = 0.95-0.98 across models), although only one of the models achieved statistical significance. Satisfaction with physician communication was lower, with less continuity across all models, but results were not statistically significant.
  
  
  CONCLUSIONS
  Hospital physician discontinuity appears to be associated with modestly increased hospital costs. Hospital physicians may revise plans as they take over patient care responsibility from their colleagues.
authors.affiliation: Systems Engineering, University Health Care System, 1350 Walton Way, Augusta, GA, 30901, USA, jonathan.turner.work@gmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Turner
authors.forename: Luke
authors.initials: L
authors.lastname: Hansen
authors.forename: Keiki
authors.initials: K
authors.lastname: Hinami
authors.forename: Nicholas
authors.initials: N
authors.lastname: Christensen
authors.forename: Jie
authors.initials: J
authors.lastname: Peng
authors.forename: Jungwha
authors.initials: J
authors.lastname: Lee
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: O'Leary
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D020445:Hospitalists / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D007087:Illinois; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012189:Retrospective Studies