Association of Communication Between Hospital-based Physicians and Primary Care Providers with Patient Outcomes
Association of Communication Between Hospital-based Physicians and Primary Care Providers with Patient Outcomes
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DOI：
10.1007/s11606-008-0882-8
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发表时间：
2009-03-01
影响因子：
5.7
通讯作者：
Meltzer, David O.
中科院分区：
文献类型：
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作者：
Bell, Chaim M.;Schnipper, Jeffrey L.;Meltzer, David O.
住进全科住院服务的患者越来越多地由以医院为基础的医生而不是他们的初级保健提供者(PCP)照顾。这种医院和门诊护理的分离可能会导致出院后重要的护理中断。我们试图确定医院医生和全科医生之间的沟通是否会影响患者的预后。从2001年7月到2003年6月，我们连续采访了6个美国学术中心的普通内科住院患者。在患者出院两周后，对同意的患者随机抽样进行PCP，并调查与医院医疗队的沟通情况。通过跟踪电话调查和国家死亡指数搜索，将回答与30天的死亡率、再次住院和急诊科(ED)就诊的综合患者结果联系起来。我们使用分层多变量Logistic回归来建模与患者PCP的沟通是否与30天的综合结果相关。共调查了2336名患者的1772个PCP，其中908个PCP应答，1078名患者可获得完整的患者随访。834名患者(77%)的初级保健医生知道他们的患者已经入院。其中，194名患者(23%)与住院医生之间进行了直接沟通，347名患者(42%)在出院后2周内获得了出院摘要。在出院后30天内，233名(22%)患者死亡、再次入院或去急诊室就诊。在调整后的分析中，没有发现综合结果与医生直接沟通(调整后的优势比0.87，95%可信区间0.56-1.34)、出院摘要(0.84，95%可信区间0.57-1.22)或初级保健医生对住院指标的知晓(1.08，95%可信区间0.73-1.59)之间的关系。尽管护理移交过程中的沟通很重要，但在这个多中心的患者样本中，我们没有发现沟通的几个方面与相关的不良临床结果之间的关系。
Patients admitted to general medicine inpatient services are increasingly cared for by hospital-based physicians rather than their primary care providers (PCPs). This separation of hospital and ambulatory care may result in important care discontinuities after discharge. We sought to determine whether communication between hospital-based physicians and PCPs influences patient outcomes.We approached consecutive patients admitted to general medicine services at six US academic centers from July 2001 to June 2003. A random sample of the PCPs for consented patients was contacted 2 weeks after patient discharge and surveyed about communication with the hospital medical team. Responses were linked with the 30-day composite patient outcomes of mortality, hospital readmission, and emergency department (ED) visits obtained through follow-up telephone survey and National Death Index search. We used hierarchical multi-variable logistic regression to model whether communication with the patient's PCP was associated with the 30-day composite outcome.A total of 1,772 PCPs for 2,336 patients were surveyed with 908 PCPs responses and complete patient follow-up available for 1,078 patients. The PCPs for 834 patients (77%) were aware that their patient had been admitted to the hospital. Of these, direct communication between PCPs and inpatient physicians took place for 194 patients (23%), and a discharge summary was available within 2 weeks of discharge for 347 patients (42%). Within 30 days of discharge, 233 (22%) patients died, were readmitted to the hospital, or visited an ED. In adjusted analyses, no relationship was seen between the composite outcome and direct physician communication (adjusted odds ratio 0.87, 95% confidence interval 0.56 - 1.34), the presence of a discharge summary (0.84, 95% CI 0.57-1.22), or PCP awareness of the index hospitalization (1.08, 95% CI 0.73-1.59).Analysis of communication between PCPs and inpatient medical teams revealed much room for improvement. Although communication during handoffs of care is important, we were not able to find a relationship between several aspects of communication and associated adverse clinical outcomes in this multi-center patient sample.