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BACKGROUND/RATIONALE:
Over 500,000 hospitalizations occur yearly in the VA system. Adverse events occur in a significant number of these. Many factors contribute to the development of adverse events; the care provided by physicians is one such factor. Past studies suggest that discontinuity of physician care can contribute to problems with patient safety, but this previous work is limited by the diffuse nature of discontinuity and the lack of an agreed-upon definition. For this proposal, physician discontinuity for hospitalized patients has been defined as the degree to which key aspects of a patient's hospitalization are performed by someone other than the physician primarily assigned to them.
OBJECTIVE(S):
The broad goal of this project is to evaluate the impact of inpatient physician discontinuity on hospitalized patients. The specific aims are 1) to describe the amount of discontinuity experienced by a group of general medical inpatients from diverse settings; 2) to determine the impact of selected aspects of discontinuity on the patient care outcomes of adverse events, test delays and readmission; and 3) to evaluate the relationship between behaviors associated with the sign-out process and the occurrence of adverse events.
METHODS:
A prospective cohort study of medical inpatients at three hospitals with different physician coverage structures and patient populations will be conducted. Data collection on discontinuity will include information about physicians' schedules and patients' admissions, hospital stays, and discharges. Three discontinuity variables will be measured: 1) percentage of hospital time covered by the primary inpatient physician; 2) time between admission and the first hand-off of care; and 3) admission-discharge discontinuity (being admitted and discharged by different physicians). Patient outcomes will include adverse events, test delays and readmission. The patient outcomes will be measured through medical record review and discharge database analysis. Comorbidity and demographic information will also be collected. Data analysis will include appropriate univariate and multivariable analyses to evaluate the hypothesized relationships between the discontinuity and the outcome variables. The results of this study will provide evidence for the theoretical link between discontinuity and patient outcomes. This study will also shed light on the mechanisms that that lead from discontinuity to adverse patient events. This will allow for the design and testing of appropriate scheduling or other systems-wide interventions to prevent adverse patient outcomes that may be secondary to discontinuity.
FINDINGS/RESULTS:
Data collection is scheduled to begin in March 2009, so no findings are available at this time.
IMPACT:
This is not applicable yet as data collection has not yet begun.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
none
Keywords:
none
MeSH Terms:
none
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