Comanagement of Hospitalized Surgical Patients by Medicine Physicians in the United States
Comanagement of Hospitalized Surgical Patients by Medicine Physicians in the United States
复制标题
DOI：
10.1001/archinternmed.2009.553
复制
发表时间：
2010-02-22
影响因子：
--
通讯作者：
Goodwin, James S.
中科院分区：
文献类型：
--
作者：
Sharma, Gulshan;Kuo, Yong-Fang;Goodwin, James S.
背景：由内科医生(全科医生或内科专科医生)管理外科患者可以提高效率，减少不良后果。我们检查了在美国普通外科手术住院期间使用共同管理的程度。方法：我们对1996-2006年间因15例住院外科手术中的1例住院的医疗保险服务费用受益人(n=694 806)进行了回顾性队列研究。我们还计算了住院期间由内科医生(全科医生或内科专科医生)支付的医疗保险受益人的比例。管理是指相关医生(全科医生或内科专科医生)在70%或以上的住院天数内提交评估和管理服务申请。结果：1996-2006年间，35.2%的普通外科手术住院患者由内科医生负责：23.7%由全科医生负责，14%由内科专科医生负责(2.5%同时由内科医生和内科专科医生负责)。从1996年到2000年，接受共同管理的患者比例相对没有变化，然后急剧上升。这一增长完全归因于多面手医生的共同管理激增。在多变量多水平分析中，从2001年到2006年，全科医生的管理每年增长11.4%。高龄、有更多合并症、或在非教学、中等规模(200-499张床位)或营利性医院接受护理的患者更有可能接受共同管理。结论：因外科手术而住院的医疗保险受益人的医疗管理正在增加，这是因为住院医生的作用越来越大。为了满足这种日益增长的管理需求，内科培训应该包括外科患者的医疗管理。
Background: Comanagement of surgical patients by medicine physicians (generalist physicians or internal medicine subspecialists) has been shown to improve efficiency and to reduce adverse outcomes. We examined the extent to which comanagement is used during hospitalizations for common surgical procedures in the United States.Methods: We conducted a retrospective cohort study of Medicare fee-for-service beneficiaries hospitalized for 1 of 15 inpatient surgical procedures from 1996 to 2006 (n=694 806). We also calculated the proportion of edicare beneficiaries comanaged by medicine physicians (generalist physicians or internal medicine subspecialists) during hospitalization. Comanagement was defined by relevant physicians ( generalist or internal medicine subspecialist) submitting a claim for evaluation and management services on 70% or more of the days that the patients were hospitalized.Results: Between 1996 and 2006, 35.2% of patients hospitalized for a common surgical procedure were comanaged by a medicine physician: 23.7% by a generalist physician and 14% by an internal medicine subspecialist (2.5% were comanaged by both). The percentage of patients experiencing comanagement was relatively unchanged from 1996 to 2000 and then increased sharply. The increase was entirely attributable to a surge in comanagement by generalist physicians. In a multivariable multilevel analysis, comanagement by generalist physicians increased 11.4% per year from 2001 to 2006. Patients with advanced age, with more comorbidities, or receiving care in nonteaching, midsize (200-499 beds), or for-profit hospitals were more likely to receive comanagement. All of the growth in comanagement was attributed to increased comanagement by hospitalist physicians.Conclusions: Medical comanagement of Medicare beneficiaries hospitalized for a surgical procedure is increasing because of the increasing role of hospitalists. To meet this growing need for comanagement, training in internal medicine should include medical management of surgical patients.