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Impact of physician training level on emergency readmission within internal medicine

Published online by Cambridge University Press:  01 November 2004

Grazyna Teresa Adamiak  and
Ingvar Karlberg
Grazyna Teresa Adamiak
Affiliation:
Stockholm, Sweden
Ingvar Karlberg
Affiliation:
Stockholm, Sweden
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Abstract

Objectives: The research question was whether training level of admitting physicians and referrals from practitioners in primary health care (PHC) are risk factors for emergency readmission within 30 days to internal medicine.

Methods: This report is a prospective multicenter study carried out during 1 month in 1997 in seven departments of internal medicine in the County of Stockholm, Sweden. Two of the units were at university hospitals, three at county hospitals and two in district hospitals. The study area is metropolitan–suburban with 1,762,924 residents. Data were analyzed by multiple logistic regression.

Results: A total of 5,131 admissions, thereby 408 unplanned readmissions (8 percent) were registered (69.8 percent of 7,348 true inpatient episodes). The risk of emergency readmission increased with patient's age and independently 1.40 times (95 percent confidence interval [CI], 1.13–1.74) when residents decided on hospitalization. Congestive heart failure as primary or comorbid condition was the main reason for unplanned readmission. Referrals from PHC were associated with risk decrease (odds ratio, 0.53; 95 percent CI, 0.38–0.73).

Conclusion: The causes of unplanned hospital readmissions are mixed. Patient contact with primary health care appears to reduce the recurrence. In addition to the diagnoses of cardiac failure, training level of admitting physicians in emergency departments was an independent risk factor for early readmission. Our conclusion is that it is cost-effective to have all decisions on admission to hospital care confirmed by senior doctors. Inappropriate selection of patients to inpatient care contributes to poor patient outcomes and reduces cost-effectiveness and quality of care.

Keywords

Emergency readmissionClinical experienceTraining levelInternal medicineReferrals
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 4 , November 2004 , pp. 516 - 523
Copyright
© 2004 Cambridge University Press

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References

Alonso Martinez JL, Llorente Diez B, Echegaray Agara M, Urbieta Echezarreta MA, Gonzalez Arenchibia C. 2001 Hospital readmission in internal medicine. Abstract. An Med Interna. 18: 248– 254.Google Scholar
Andersson G, Karlberg I. 2001 Lack of integration and seasonal variation in demand explained performance problems and waiting times for patients at emergency departments: A 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals. Health Policy. 55: 187– 207.Google Scholar
Antonelli Incalzi R, Fuso L, Serra M, et al. 2002 Exacerbated chronic obstructive pulmonary disease: A frequently unrecognized condition. J Intern Med. 252: 48– 55.Google Scholar
Benbassat J, Taragin M. 2000 Hospital Readmissions as a Measure of Quality of Health Care. Advantages and Limitations. Arch Intern Med. 160: 1074– 1081.Google Scholar
Brook RH, McGlynn EA, Cleary PD. 1996 Part 2: Measuring quality of care. N Engl J Med. 335: 966– 970.Google Scholar
Cardin S, Afilalo M, Lang E, et al. 2003 Intervention to decrease emergency department crowding: Does it have an effect on return visits and hospital readmissions. Ann Emerg Med. 2: 173– 185.Google Scholar
Cline CMJ, Israelsson BYA, Willenheimer RB, Broms K, Erhardt LR. 1998 Cost-effective management programme for heart failure reduces hospitalisation. Heart. 80: 442– 446.Google Scholar
Derlet RW. 2002 Editorials. Overcrowding in emergency departments: Increased demand and decreased capacity. Ann Emerg Med. 4: 430– 432.Google Scholar
Donabedian A. 2000 Evaluating physician competence, perspectives. Bull World Health Organ. 786 (6): 857– 860. (Lecture by Donabedian A at a Conference on Assessing Physician Performance, held in San Francisco, USA in 1976 by American Society of Internal Medicine; Ref No 00-0753).Google Scholar
Ebrahim S. 1999 Demographic shifts and medical training. BMJ. 319: 1358– 1360.Google Scholar
Eriksen BO, Kristiansen IS, Nord E, et al. 1999 The cost of inappropriate admissions: A study of health benefits and resource utilisation in a department of internal medicine. J Intern Med. 246: 379– 387.Google Scholar
FCC, Federation of County Councils. 1999. Statistical annual book for county councils 1999. Stockholm: Federation of County Councils;
Feenstra J, Grobbee DE, Jonkman FAM, Hoes AW, Stricker BHCh. 1998 Prevention of relapse in patients with congestive heart failure: The role of precipitating factors. Heart. 80: 432– 436.Google Scholar
Flood AB. 1994 The impact of organisational and management factors on the quality of care in health care organisations. Med Care Rev. 51: 381– 429.Google Scholar
Gupta M, Tabas JA, Kohn MA. 2002 Presenting complaint among patients with myocardial infarction who present to an urban, public hospital emergency department. Ann Emerg Med. 40: 180– 186.Google Scholar
Holloway JJ, Thomas JW. 1989: Factors influencing readmission risk: Implications for quality monitoring, Health Care Financing-Rev. 11– 19.Google Scholar
Katz MH. 1999. Multivariable analysis. United Kingdom: Cambridge University Press;
Kazandjian VA, Matthes N, Wicker KG. 2003 Are performance indicators generic? The international experience of the Quality Indicator project. J Eval Clin Pract. 9: 265– 276.Google Scholar
Kossovsky MP, Perneger TV, Sarasin FP, et al. 1999 Comparison between planned and unplanned readmissions to a department of internal medicine. J Clin Epidemiol. 52: 151– 156.Google Scholar
Lau AC-W, Yam LY-C, Poon E. 2001: Hospital re-admission in patients with acute exacerbation of chronic obstructive pulmonary disease. Respir Med. 95: 876– 884.Google Scholar
Lowe RA, Abbuhl SB. 2001 Appropriate standards for “Appropriateness” research. Ann Emerg Med. 37: 629– 632.Google Scholar
Marcantonio ER, McKean S, Goldfinger M, et al. 1999 Factors associated with unplanned hospital readmission among patients 65 years of age and older in a medicare managed care plan. Am J Med. 107: 13– 17.Google Scholar
McKee M, Black N. 1992 Does the current use of junior doctors in the United Kingdom affect the quality of medical care? Soc Sci Med. 5: 549– 558.Google Scholar
Michalsen A, König G, Thimme W. 1998 Preventable causative factors leading to hospital admission with decompensated heart failure. Heart. 80: 437– 441.Google Scholar
Miles TA, Lowe J. 1999 Are unplanned readmissions to hospital really preventable? J Qual Clin Pract. 19: 211– 214.Google Scholar
Mitchell PH, Shortell SM. 1997 Adverse outcomes and variations in organisation of care delivery. Medi Care. 35 (Suppl): NS19– NS32.Google Scholar
NBHW, National Board of Health and Welfare, Association of Swedish Municipalities, National Institute of Statistics. 1997. Benchmark for social services 1996. (Jämförelsetal för socialtjänsten 1996). Stockholm: Report number 1997-00-057.
NHS Performance Indicators: July 2000. Technical specifications - Health outcomes of NHS Health Care (Part 1). Available at: URL:http://www.doh.gov.uk/nhsperformanceindicators/hlpi2000/h1137s.html.
Panis L, Verheggen FW, Prins MH. 2003 Rapid response: The jumble of appropriateness. BMJ. 326: 927– 928. Available at: http://bmj.bmjjournals.com/cgi/eletters/326/7395/927#31974.Google Scholar
Rosborough TK. 1998 Editorials. Doctors in training: Wasteful and inefficient? BMJ. 316: 1107– 1108.Google Scholar
Rydén-Bergsten T, Andersson F. 1999 The health care costs of heart failure in Sweden. J Intern Med. 246: 275– 284.Google Scholar
Turrell AR, Castleden M. 1999 Improving the emergency medical treatment of older nursing-home residents. Age Ageing. 28: 77– 82.Google Scholar
Wesley Dent A, Phillips GA, Chenhall AJ, McGregor LR. 2003 The heaviest repeat users of an inner city emergency department are not general practice patients. Emerg Med. 15: 322– 329.Google Scholar
West E. 2000 Organisational sources of safety and danger: Sociological contributions to the study of adverse events. Qual Health Care. 9: 120– 126.Google Scholar
West E. 2001 Management matters: The link between hospital organisation and quality of patient care. Qual Health Care. 10: 40– 48.Google Scholar
Wu AW, Folkman S, McPhee SJ, Lo B. 2003 Do house officers learn from their mistakes? Qual Safety Health Care. 12: 221– 228.Google Scholar