Physician-level variation in clinical outcomes and resource use in inpatient general internal medicine: an observational study
| Autor: | Fahad Razak, Janice L. Kwan, Shail Rawal, Lauren Lapointe-Shaw, Yishan Guo, Muhammad Mamdani, Andreas Laupacis, Adina Weinerman, Terence Tang, Hae Young Jung, Amol A. Verma, Allan S. Detsky |
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| Rok vydání: | 2020 |
| Předmět: |
Ontario
Inpatients Matching (statistics) medicine.medical_specialty business.industry Health Policy Health services research Length of Stay 030204 cardiovascular system & hematology Patient Readmission Hospital medicine 03 medical and health sciences 0302 clinical medicine Quartile Physicians Internal medicine Propensity score matching Internal Medicine Humans Resource use Medicine Observational study 030212 general & internal medicine business Patient factors |
| Zdroj: | BMJ Quality & Safety. 30:123-132 |
| ISSN: | 2044-5423 2044-5415 |
| DOI: | 10.1136/bmjqs-2019-010425 |
| Popis: | BackgroundVariations in inpatient medical care are typically attributed to system, hospital or patient factors. Little is known about variations at the physician level within hospitals. We described the physician-level variation in clinical outcomes and resource use in general internal medicine (GIM).MethodsThis was an observational study of all emergency admissions to GIM at seven hospitals in Ontario, Canada, over a 5-year period between 2010 and 2015. Physician-level variations in inpatient mortality, hospital length of stay, 30-day readmission and use of ‘advanced imaging’ (CT, MRI or ultrasound scans) were measured. Physicians were categorised into quartiles within each hospital for each outcome and then quartiles were pooled across all hospitals (eg, physicians in the highest quartile at each hospital were grouped together). We report absolute differences between physicians in the highest and lowest quartiles after matching admissions based on propensity scores to account for patient-level variation.ResultsThe sample included 103 085 admissions to 135 attending physicians. After propensity score matching, the difference between physicians in the highest and lowest quartiles for in-hospital mortality was 2.4% (95% CI 0.6% to 4.3%, pConclusionsPatient outcomes and resource use in inpatient medical care varied substantially across physicians in this study. Physician-level variations in length of stay and imaging use were unlikely to be explained by patient factors whereas differences in mortality and readmission should be interpreted with caution and could be explained by unmeasured confounders. Physician-level variations may represent practice differences that highlight quality improvement opportunities. |
| Databáze: | OpenAIRE |
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