U.S. trends in hospitalization and generalist physician workforce and the emergence of hospitalists.
U.S. trends in hospitalization and generalist physician workforce and the emergence of hospitalists.
复制标题
美国住院治疗和全科医生队伍的趋势以及住院医生的出现。
DOI：
10.1007/s11606-010-1276-2
复制
发表时间：
2010
影响因子：
5.7
通讯作者：
Chung,JeanetteW
中科院分区：
文献类型：
--
作者：
Meltzer,DavidO;Chung,JeanetteW
背景普通内科医生和其他全科医师传统上在门诊和住院期间照顾患者。有人认为，自 20 世纪 90 年代中期以来住院医生的扩张已经“挤出”了住院护理领域的全科医生。然而，相对于全科医师队伍规模而言，医院利用率的下降也有可能降低了全科医师继续提供医院护理的动力。目的研究美国住院医师出现前后医院利用率和全科医师队伍的趋势，并调查导致这些趋势的因素。设计利用 1980-2005 年国家医院出院调查的住院患者就诊数据和美国医学会的医生人力数据，我们确定了住院医师出现前后的全国趋势。住院医师的年度住院就诊人数相对于全科医师的数量。结果在住院医师出现之前，住院医师相对于全科医师的就诊人数稳步下降。住院病人数量相对于全科医师数量的下降主要是由于住院时间的缩短和全科医师人数的增加。结论在住院医师出现之前，医院利用率相对于全科医师人数的下降，主要是由于住院时间的缩短和全科医师人数的增加。这可能削弱了提供医院护理的通才动机。寻求保留门诊和住院双重综合护理的护理模式如果关注住院风险高的患者，则最有可能是可行的。
BackgroundGeneral internists and other generalist physicians have traditionally cared for their patients during both ambulatory visits and hospitalizations. It has been suggested that the expansion of hospitalists since the mid-1990s has “crowded out” generalists from inpatient care. However, it is also possible that declining hospital utilization relative to the size of the generalist workforce reduced the incentives for generalists to continue providing hospital care.ObjectiveTo examine trends in hospital utilization and the generalist workforce before and after the emergence of hospitalists in the U.S. and to investigate factors contributing to these trends.DesignUsing data from 1980–2005 on inpatient visits from the National Hospital Discharge Survey, and physician manpower data from the American Medical Association, we identified national trends before and after the emergence of hospitalists in the annual number of inpatient encounters relative to the number of generalists.ResultsInpatient encounters relative to the number of generalists declined steadily before the emergence of hospitalists. Declines in inpatient encounters relative to the number of generalists were driven primarily by reduced hospital length of stay and increased numbers of generalists.ConclusionsHospital utilization relative to generalist workforce declined before the emergence of hospitalists, largely due to declining length of stay and rising generalist workforce. This likely weakened generalist incentives to provide hospital care. Models of care that seek to preserve dual-setting generalist care spanning ambulatory and inpatient settings are most likely to be viable if they focus on patients at high risk of hospitalization.