Fragmentation of Care

In a recent article in the Journal of Hospital Medicine, a study showed the number of physicians overseeing a patient's care has a significant effect on that individual's length of stay in the hospital.

There has been a lot of talk about how to balance work hours in physicians but much less focus has been given to the impact of discontinuity of care on patient length of stay and other utilization and quality measures.

This study looked at 1724 patients admitted to hospitalists with pneumonia and its complications and 8509 patients admitted with heart failure and shock between December 2006 and November 2007 at 223 hospitals across the country.

The results showed that patients with pneumonia had a mean length of stay (LOS) of 5.81 days, and those with heart failure had a mean LOS of 4.69 days, but for every 10% increase in fragmentation of care by the changing hospitalists, LOS increased by 0.45 days for people with pneumonia and 0.38 days for people with heart failure.

There was not shown to be an increase in the complication rate, but just in the length of stay.
Although this study only looked at hospitalists, fragmentation of care among all providers probably plays some role in increasing the length of stay.

I think for primary care physicians who typically are the coordinators of care; it would make sense to ensure continuity of care as much as possible.