Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population.
Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population.
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DOI：
10.1001/jamainternmed.2017.7049
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发表时间：
2018-02-01
影响因子：
39
通讯作者：
Nattinger AB
中科院分区：
文献类型：
--
作者：
Goodwin JS;Salameh H;Zhou J;Singh S;Kuo YF;Nattinger AB
相当数量的住院医师是住院医师培训计划的应届毕业生。目前缺乏关于住院医师年经验对患者结局影响的数据。描述住院医师年数与患者30天死亡率和住院死亡率之间的关系。我们使用了5%的国家医疗保险数据样本的病人和医院的特点，建立了一个多层次的逻辑回归模型，预测死亡率作为一个功能的多年的经验，医院。我们创造了两个群体。第一个是2013年7月1日至2014年6月30日期间工作的21612名住院医师的横断面队列，并进行了5年的回顾期，以评估他们作为住院医师的既往经验，第二个是2008年7月1日至2011年6月30日期间第一年实践的3860名住院医师的纵向队列。在医院行医至少4年的人。入院后30天死亡率经患者和医院特征校正后的3水平logistic回归模型住院死亡率是次要结局。在2013年7月1日至2014年6月30日期间照顾Medicare住院患者的21612名住院医生中，5445名（25%）具有1年或更少的经验，而11596名（54%）具有4年或更长的经验。然后，我们确定了3860名医生在他们的第一年作为住院医生谁继续实践作为住院医生4年。住院经验与死亡率之间存在显著相关性。第一年住院患者的30天死亡率为10.50%，第二年住院患者的30天死亡率为9.97%。与第一年住院患者相比，第二年住院患者的死亡率比值为0.90（95%CI，0.84-0.96）。第一年住院医生护理的患者的住院死亡率为3.33%，第二年住院医生为2.96%。(odds比值，0.84; 95%CI，0.75-0.95）。对于30天和住院死亡率，第二年和随后几年的经验之间的死亡率变化不大。住院医生在第一年的实践中照顾的患者死亡率较高。早期职业医院医生可能需要额外的支持，以确保他们的病人的最佳结果。
Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking. To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. We used a 5%sample of national Medicare data of patient and hospital characteristics to build a multilevel logistic regression model to predict mortality as a function of years of experience of the hospitalists. We created 2 cohorts. The first was a cross-sectional cohort of 21 612 hospitalists working between July 1, 2013, and June 30, 2014, with a 5-year look-back period to assess their years of prior experience as a hospitalist, and the second was a longitudinal cohort of 3860 hospitalists in their first year of practice between July 1, 2008, and June 30, 2011, who continued practicing hospital medicine for at least 4 years. Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome. Among 21 612 hospitalists caring for Medicare inpatients from July 1, 2013, to June 30, 2014, 5445 (25%) had 1 year of experience or less, while 11 596 (54%) had 4 years of experience or more. We then identified 3860 physicians in their first year as hospitalists who continued to practice as hospitalists for 4 years. There was a significant association between hospitalist experience and mortality. Observed 30-day mortality was 10.50% for patients of first-year hospitalists vs 9.97%for patients of hospitalists in their second year. The mortality odds for patients of second-year hospitalists were 0.90 (95%CI, 0.84–0.96) compared with patients of first-year hospitalists. Observed hospital mortality was 3.33%for patients cared for by first-year hospitalists vs 2.96%for second-year hospitalists. (odds ratio, 0.84; 95%CI, 0.75–0.95). For both 30-day and hospital mortality, there was little change in odds of mortality between the second year and subsequent years of experience. Patients cared for by hospitalists in their first year of practice experience higher mortality. Early-career hospitalists may require additional support to ensure optimal outcomes for their patients.
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