Faculty Collaboration Database

Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population. JAMA Intern Med 2018 Feb 01;178(2):196-203

Date

12/28/2017

Pubmed ID

29279886

Pubmed Central ID

PMC5801052

DOI

10.1001/jamainternmed.2017.7049

Scopus ID

2-s2.0-85041684788 (requires institutional sign-in at Scopus site)   34 Citations

Abstract

IMPORTANCE: 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.

OBJECTIVE: To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients.

DESIGN, SETTING, AND PARTICIPANTS: 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.

MAIN OUTCOMES AND MEASURES: Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome.

RESULTS: 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.

CONCLUSIONS AND RELEVANCE: 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.

Author List

Goodwin JS, Salameh H, Zhou J, Singh S, Kuo YF, Nattinger AB

Author

Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cross-Sectional Studies
Female
Hospital Costs
Hospital Mortality
Hospitalists
Hospitalization
Humans
Male
Medicare
Middle Aged
Retrospective Studies
Survival Rate
United States