Hospitalists’ Schedules that Promote Inpatient Continuity are Associated with Better Outcomes

Hospitalist schedules that promote inpatient continuity of care may be associated with better outcomes of hospitalization, according to a new study published in JAMA Internal Medicine.

“The working schedules of hospitalists vary widely. Discontinuous schedules, such as 24 hours on and 48 hours off, result in several hospitalists providing care during a patient’s hospital stay. Poor continuity of care during hospitalization may be associated with poor patient outcomes,” the research authors wrote in their abstract.

In this retrospective cohort study, researchers used conditional models to assessed Medicare claims data for 114,777 patients admitted to the hospital (mean age, 80) with a 3-day to 6-day length of stay from January 1, 2014, through November 30, 2016, who received all general medical care from hospitalists in 229 hospitals in Texas. For each hospital admission, they weighted the average schedule continuity for the treating hospitalists, calculated as the percentage of all their working days in that year that were part of a block of seven or more consecutive working days. The primary endpoint of this study was defined as patient mortality in the 30 days after discharge, while the secondary outcomes were stipulated as readmission rates and Medicare costs in the 30 days after discharge, and discharge destination. The researchers analyzed data from November 2018 to June 2019.

According to the results of the study, admissions in the lowest quartile for continuity of hospitalist schedules, the hospitalists providing care worked 0% to 30% of their total working days as part of a block of seven or more consecutive days vs 67% to 100% for hospitalists providing care for patients in the highest quartile for continuity. The researchers observed that patient characteristics were not linked the continuity of working schedules for the hospitalist(s) providing care.

Moreover, in conditional logistic regression models, admitted patients cared for by hospitalists in the highest quartile of schedule continuity had lower 30-day mortality after discharge (aOR=0.88; 95% CI, 0.81 to 0.95), lower readmission rates (aOR=0.94; 95% CI, 0.90 to 0.99), higher rates of discharge to the home (aOR=1.08; 95% CI, 1.03 to 1.13), and lower 30-day postdischarge costs (−$223; 95% CI, −$441 to −$7). The results were similar across a range of different methods for defining continuity of hospitalist schedules and selecting the cohort.

The authors wrote in their conclusion that: “Admitted patients receiving care from hospitalists with schedules that promote inpatient continuity of care may experience better outcomes of hospitalization.”