Longer Lengths of Stay and Higher Risk of Mortality among Inpatients of Physicians with More Years in Practice
Longer Lengths of Stay and Higher Risk of Mortality among Inpatients of Physicians with More Years in Practice
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DOI：
10.1016/j.amjmed.2011.04.011
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发表时间：
2011-09-01
影响因子：
5.9
通讯作者：
Arnsten, Julia H.
中科院分区：
文献类型：
--
作者：
Southern, William N.;Bellin, Eran Y.;Arnsten, Julia H.
背景：更多的医生从业年数与更少的指南依从性相关，但尚不清楚从业年数是否与患者预后相关。方法：对2002年7月1日至2004年6月30日在某城市医院接受教学服务的住院患者进行调查。入院者准随机分配给主治医生。从业年数定义为主治医师持有行医执照的年数。我们将医生分为4组（0-5岁、6-10岁、11-20岁和20岁以下），并使用负二项和逻辑回归来调整患者特征，并估计执业年数与住院时间、再入院和死亡率之间的关系。结果：共检查59名医生和6572名入院患者。虽然4组住院患者具有相似的人口学和临床特征，但执业年限越长的医生平均住院时间越长（0-5年、6-10年、11-20年和10 -20年的医生平均住院时间分别为4.77、5.29、5.42和5.31天，P = .001）。调整后，从业20年以上医师的住院患者住院死亡率（优势比1.71,95%可信区间1.06 ~ 2.76）和30天死亡率（优势比1.51,95%可信区间1.06 ~ 2.16）均高于从业0 ~ 5年医师的住院患者。结论：住院医师执业年限越长，死亡风险越高。应制定护理质量干预措施，以保持医生的住院技能。(C) 2011爱思唯尔公司版权所有。美国医学杂志（2011）124,868-874
BACKGROUND: More physician years in practice have been associated with less frequent guideline adherence, but it is unknown whether years in practice are associated with patient outcomes.METHODS: We examined all inpatients on the teaching service of an urban hospital from July 1, 2002 through June 30, 2004. Admissions were assigned to attending physicians quasi-randomly. Years in practice was defined as the number of years the attending physician held a medical license. We divided physicians into 4 groups (0-5, 6-10, 11-20, and >20 years in practice), and used negative binomial and logistic regression to adjust for patient characteristics and estimate associations between years in practice and length-of-stay, readmission, and mortality.RESULTS: Fifty-nine physicians and 6572 admissions were examined. Although the 4 inpatient groups had similar demographic and clinical characteristics, physicians with more years in practice had longer mean lengths of stay (4.77, 5.29, 5.42, and 5.31 days for physicians with 0-5, 6-10, 11-20, and >20 years in practice, respectively, P = .001). After adjustment, inpatients of physicians with more than 20 years in practice had higher risk for both in-hospital mortality (odds ratio 1.71; 95% confidence interval, 1.06-2.76) and 30-day mortality (odds ratio 1.51, 95% confidence interval, 1.06-2.16) than inpatients of physicians with 0-5 years in practice.CONCLUSION: Inpatient care by physicians with more years in practice is associated with higher risk of mortality. Quality-of-care interventions should be developed to maintain inpatient skills for physicians. (C) 2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 868-874