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Comment & Response
April 2018

Concerns Regarding Resource Use and Outcomes in Subsets of Clinicians

Author Affiliations
  • 1Departments of Medicine and Dentistry, University of Alberta, Edmonton, Canada
JAMA Intern Med. 2018;178(4):580. doi:10.1001/jamainternmed.2018.0206

To the Editor I read with interest the recent Original Investigation by Stevens et al1 comparing resource use and outcomes for patients cared for by different types of physicians. Although much of the focus was on length of stay and in-hospital resource use, I was struck by their finding that hospitalized patients cared for by their usual primary care physician were more likely to be discharged home and had lower mortality rates in the 30 days after discharge.1 To fully explore potential explanations for these findings beyond those offered by the authors or the editorialists, one other key piece of information is needed. Do the authors have any data on postdischarge follow-up patterns for the patients cared for by hospitalists, primary care physicians, or generalists? Specifically, are patients discharged by their own primary care physician more likely to have prompt outpatient follow-up after discharge and less likely to be seen by a physician unfamiliar with them? In a recent analysis of nearly 40 000 patients with heart failure presenting to acute care hospitals in the Canadian province of Alberta,2 we found that early (within 2 weeks of discharge) outpatient follow-up with any physician was associated with reduced risk of a repeat emergency department visit. However, only outpatient follow-up with a familiar physician was associated with statistically significantly lower rates of subsequent death or readmission.2 The benefits of physician continuity between the inpatient and outpatient settings appear to be just as important after discharge3 as Stevens et al1 demonstrated for outpatient-inpatient continuity prior to admission.

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