Inpatient-outpatient transitions for patients with resident primary care physicians: access and readmission.
BACKGROUND
Transition from hospitalization to postdischarge care is a vulnerable period for patients. How the experience of this transition differs for patients with resident primary care physicians is unknown.


METHODS
In a single, large academic primary care practice, we examined an inception cohort of consecutive hospitalizations and postdischarge visits of hospitalized patients with resident or faculty primary care physicians between 2008 and 2013. We compared patient demographics, readmission risk, and access to outpatient care between resident and faculty primary care physicians by using generalized estimating equations to account for repeated hospitalizations.


RESULTS
We documented 8161 hospitalizations among patients with resident primary care physicians and 20,844 hospitalizations among patients with faculty primary care physicians. Hospitalized patients with resident primary care physicians were generally younger, more likely to be on Medicaid, and more likely to be African American (P < .001). Patients with resident primary care physicians were less likely to be seen within 7 and 30 days of discharge (adjusted relative risk, 0.83; 95% confidence interval [CI], 0.81-0.93 at 7 days; adjusted relative risk, 0.88; 95% CI, 0.85-0.92 at 30 days) and had an increased risk of readmission within 30 days (adjusted odds ratio, 1.25; 95% CI, 1.13-1.37). They also were considerably less likely to see their own provider at first follow-up (relative risk, 0.55; 95% CI, 0.52-0.59).


CONCLUSIONS
Hospitalized patients with resident primary care physicians had lower rates of timely postdischarge follow-up, higher rates of readmission, and a lower likelihood of seeing their own provider than did patients with faculty primary care physicians. These findings highlight the challenges facing academic centers for patients with resident primary care physicians.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass. Electronic address: ldoctoro@bidmc.harvard.edu.
Lauren
L
Doctoroff
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.
Diane
D
McNally
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.
Anita
A
Vanka
Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, Fla.
Ryan
R
Nall
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.
Kenneth J
KJ
Mukamal
D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D001900:Boston; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005180:Faculty, Medical; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012044:Regression Analysis
Ambulatory care; Hospital readmission; Internship and residency