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Physician Continuity from Outpatient to Inpatient Care Is Declining

The surge in hospitalist care is among several factors responsible.

Continuity of physician care from outpatient to inpatient settings appears to be declining because of organizational changes in medical practice, including the growth of hospitalist medicine. In this study, researchers used a Medicare claims database for 3 million hospitalized adults to explore the perceived decline in continuity.

Continuity of inpatient care with any prior outpatient physician (i.e., one who submitted at least one outpatient bill in the prior year) declined from about 50% of cases in 1996 to 40% in 2006. Continuity of inpatient care with a primary care physician (i.e., a general practitioner, family physician, internist, or geriatrician who submitted at least 3 outpatient bills in the prior year) declined from 44% of hospitalizations in 1996 to 32% in 2006. Greater declines in continuity were associated with weekend admissions, larger metropolitan areas, hospitalist care, and major teaching hospitals.

Comment: These data confirm what most physicians and patients already suspected: Continuity of care between the outpatient and inpatient settings is low and declining. Whether outpatient-to-inpatient continuity has identifiable benefits that might outweigh the presumed benefits of hospitalist care is unclear. However, financial and logistical pressures might have settled this question already by pushing outpatient and primary care physicians out of hospitals.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine April 30, 2009

Citation(s):

Sharma G et al. Continuity of outpatient and inpatient care by primary care physicians for hospitalized older adults. JAMA 2009 Apr 22/29; 301:1671.

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• Continuity of hospital care
  Mildred M. Jensen, 1 May 2009 3:10 PM EST
  During a hospital stay last August, I was seen by 10 different doctors, over a 4 day period, some of... [more]
• Continuity of Care
  Peter C. Jamieson, Calgary, Canada, 4 May 2009 8:29 AM EST
  The balancing measure that should be explored is access to community care and continuity in the outpatient setting. Prehaps the... [more]
• Decline in Physician Continuity
  Martha J Lynch PA-C, 4 May 2009 8:29 AM EST
  As with most trends which are adopted to reduce costs and maintain best clinical outcomes for patients, Hospitalist practice has... [more]
• Continuity of Hospital Care
  Cynthia Rothschild, 4 May 2009 8:29 AM EST
  My 86 y-o mother was admitted to our small local hospital from the emergency rm. in Aug, 08. I lost... [more]