Association of weekend continuity of care with hospital length of stay

Saul Blecker, Danie Shine, Naeun Park, Keith Goldfeld, R. Scott Braithwaite, Martha J. Radford, Marc Gourevitch

Research output: Contribution to journalArticle

Abstract

Objective. The purpose of this study was to evaluate the association of physician continuity of care with length of stay, likelihoodof weekend discharge, in-hospital mortality and 30-day readmission.Design. A cohort study of hospitalized medical patients. The primary exposure was the weekend usual provider continuity(UPC) over the initial weekend of care. This metric was adapted from an outpatient continuity of care index. Regression modelswere developed to determine the association between UPC and outcomes.Setting. An academic medical center.Main outcome measure. Length of stay which was calculated as the number of days from the first Saturday of the hospitalizationto the day of discharge.Results. Of the 3391 patients included in this study, the prevalence of low, moderate and high UPC for the initial weekend ofhospitalization was 58.7, 22.3 and 19.1%, respectively. When compared with low continuity of care, both moderate and high continuityof care were associated with reduced length of stay, with adjusted rate ratios of 0.92 (95% CI 0.86-1.00) and 0.64 (95% CI0.53-0.76), respectively. High continuity of care was associated with likelihood of weekend discharge (adjusted odds ratio 2.84,95% CI 2.11-3.83) but was not significantly associated with mortality (adjusted odds ratio 0.72, 95% CI 0.29-1.80) or readmission(adjusted odds ratio 0.88, 95% CI 0.68-1.14) when compared with low continuity of care.Conclusions. Increased weekend continuity of care is associated with reduced length of stay. Improvement in weekend crosscoverageand patient handoffs may be useful to improve clinical outcomes.

Original languageEnglish (US)
Pages (from-to)530-537
Number of pages8
JournalInternational Journal for Quality in Health Care
Volume26
Issue number5
DOIs
StatePublished - Oct 1 2014

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Continuity of Patient Care
Length of Stay
Odds Ratio
Ambulatory Care
Hospital Mortality
Cohort Studies
Cross-Sectional Studies
Outcome Assessment (Health Care)
Physicians
Mortality

Keywords

  • Continuity of care
  • Hospital
  • Length of stay

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Association of weekend continuity of care with hospital length of stay. / Blecker, Saul; Shine, Danie; Park, Naeun; Goldfeld, Keith; Braithwaite, R. Scott; Radford, Martha J.; Gourevitch, Marc.

In: International Journal for Quality in Health Care, Vol. 26, No. 5, 01.10.2014, p. 530-537.

Research output: Contribution to journalArticle

Blecker, S, Shine, D, Park, N, Goldfeld, K, Braithwaite, RS, Radford, MJ & Gourevitch, M 2014, 'Association of weekend continuity of care with hospital length of stay', International Journal for Quality in Health Care, vol. 26, no. 5, pp. 530-537. https://doi.org/10.1093/intqhc/mzu065
Blecker S, Shine D, Park N, Goldfeld K, Braithwaite RS, Radford MJ et al. Association of weekend continuity of care with hospital length of stay. International Journal for Quality in Health Care. 2014 Oct 1;26(5):530-537. https://doi.org/10.1093/intqhc/mzu065
Blecker, Saul ; Shine, Danie ; Park, Naeun ; Goldfeld, Keith ; Braithwaite, R. Scott ; Radford, Martha J. ; Gourevitch, Marc. / Association of weekend continuity of care with hospital length of stay. In: International Journal for Quality in Health Care. 2014 ; Vol. 26, No. 5. pp. 530-537.
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AU - Shine, Danie

AU - Park, Naeun

AU - Goldfeld, Keith

AU - Braithwaite, R. Scott

AU - Radford, Martha J.

AU - Gourevitch, Marc

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N2 - Objective. The purpose of this study was to evaluate the association of physician continuity of care with length of stay, likelihoodof weekend discharge, in-hospital mortality and 30-day readmission.Design. A cohort study of hospitalized medical patients. The primary exposure was the weekend usual provider continuity(UPC) over the initial weekend of care. This metric was adapted from an outpatient continuity of care index. Regression modelswere developed to determine the association between UPC and outcomes.Setting. An academic medical center.Main outcome measure. Length of stay which was calculated as the number of days from the first Saturday of the hospitalizationto the day of discharge.Results. Of the 3391 patients included in this study, the prevalence of low, moderate and high UPC for the initial weekend ofhospitalization was 58.7, 22.3 and 19.1%, respectively. When compared with low continuity of care, both moderate and high continuityof care were associated with reduced length of stay, with adjusted rate ratios of 0.92 (95% CI 0.86-1.00) and 0.64 (95% CI0.53-0.76), respectively. High continuity of care was associated with likelihood of weekend discharge (adjusted odds ratio 2.84,95% CI 2.11-3.83) but was not significantly associated with mortality (adjusted odds ratio 0.72, 95% CI 0.29-1.80) or readmission(adjusted odds ratio 0.88, 95% CI 0.68-1.14) when compared with low continuity of care.Conclusions. Increased weekend continuity of care is associated with reduced length of stay. Improvement in weekend crosscoverageand patient handoffs may be useful to improve clinical outcomes.

AB - Objective. The purpose of this study was to evaluate the association of physician continuity of care with length of stay, likelihoodof weekend discharge, in-hospital mortality and 30-day readmission.Design. A cohort study of hospitalized medical patients. The primary exposure was the weekend usual provider continuity(UPC) over the initial weekend of care. This metric was adapted from an outpatient continuity of care index. Regression modelswere developed to determine the association between UPC and outcomes.Setting. An academic medical center.Main outcome measure. Length of stay which was calculated as the number of days from the first Saturday of the hospitalizationto the day of discharge.Results. Of the 3391 patients included in this study, the prevalence of low, moderate and high UPC for the initial weekend ofhospitalization was 58.7, 22.3 and 19.1%, respectively. When compared with low continuity of care, both moderate and high continuityof care were associated with reduced length of stay, with adjusted rate ratios of 0.92 (95% CI 0.86-1.00) and 0.64 (95% CI0.53-0.76), respectively. High continuity of care was associated with likelihood of weekend discharge (adjusted odds ratio 2.84,95% CI 2.11-3.83) but was not significantly associated with mortality (adjusted odds ratio 0.72, 95% CI 0.29-1.80) or readmission(adjusted odds ratio 0.88, 95% CI 0.68-1.14) when compared with low continuity of care.Conclusions. Increased weekend continuity of care is associated with reduced length of stay. Improvement in weekend crosscoverageand patient handoffs may be useful to improve clinical outcomes.

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