REPORTING FROM NAPCRG 2017
MONTREAL (FRONTLINE MEDICAL NEWS) – When a family medicine teaching service provided hospital care for local patients, length of stay was almost a third shorter than when care was provided by the hospitalist internal medicine service at a large tertiary care hospital.
What made the difference in length of stay? “Our family medicine service is more familiar with outpatient resources available in the community to help local patients transition from hospital to home,” said Gregory Garrison, MD, of the department of family medicine at the Mayo Clinic, Rochester, Minn. He noted that readmission rates weren’t higher for the patients cared for by the family medicine inpatient service.
In a retrospective cohort study, Dr. Garrison and his colleagues looked at the hospitalization records for local family medicine patients who were discharged from the family medicine or the hospitalist internal medicine services during the 2-year period from 2011 to 2013 at the Mayo Clinic hospital. Patients who primarily received care from subspecialty services were excluded.
The primary outcome measures were length of stay and readmission or death within 30 days of discharge, Dr. Garrison said at the annual meeting of the North American Primary Care Research Group.
A total of 3,125 admissions were seen for 2,138 unique patients. Most admissions (2,651; 84.8%) were for the family medicine service. Demographic characteristics and readmission rates were similar between admissions to the two services, but “hospitalist internal medicine patients were perhaps slightly sicker,” said Dr. Garrison. The mean Charlson comorbidity score was 4 for the family medicine admissions and 5.6 for the hospitalist internal medicine admissions (P less than .001). Also, the patients admitted to the hospitalist service were slightly more likely to have had a previous hospital admission within the prior 12 months.
Examining the unadjusted data, Dr. Garrison and his colleagues found that the family medicine patients had a shorter length of stay, with a mean 2.5 days and a median 1.8 days, compared with the mean 3.8 days and median 2.7 days spent in hospital for the hospitalist internal medicine patients.
The difference remained significant after multivariable analysis to control for several potentially confounding factors, including patient demographics, prior health care utilization, disposition, readmissions, and Charlson comorbidity score.
The adjusted figures showed that length of stay was 31.8% longer for admissions to the hospitalist internal medicine service than for the family medicine service.
In discussion, Dr. Garrison said that he and his colleagues believe that the physicians, social workers, and clinical assistants who make up the family medicine service really understand the “outpatient resources that can be marshaled to help local patients with the transition from hospital to home.”
In practical terms, this can mean that a social worker knows which skilled nursing facilities are likely to accept a Friday admission, or that a physician understands community resources that can help an elderly patient return to her home with a little extra support, he said.
Another practicality, is that “the lack of a census cap on the family medicine inpatient service may incentivize rapid turnover,” he added.
Dr. Garrison reported no outside sources of funding and no conflicts of interest.
SOURCE: Garrison G et al. NAPCRG 2017 Abstract AE32