Inpatients treated by their primary care physicians have lower mortality rates, study finds

Inpatients who are cared for by their primary care physicians have lower mortality rates than those treated by hospitalists, according to a new study published in JAMA Internal Medicine. 

Researchers examined more than 560,000 admissions recorded in 2013 for the 20 most common diagnoses among Medicare fee-for-service patients. Patients cared for by PCPs had a lower adjusted 30-day mortality rate than hospitalists, 8.6% compared to 10.8%. 

Other generalists, who may not have a pre-existing relationship with the patient or knowledge of the hospital, had the highest mortality rates at 11%, according to the study. 

Primary care doctors were also the most likely to discharge patients to their homes instead of to long-term care facilities. Patients treated by their PCPs also had slightly lower seven-day readmission rates when compared to hospitalists and other generalists, though 30-day rates were similar between PCPs and hospitalists and worse for other generalists. 

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"I think what we can draw from this study is that the prior relationship with a physician has meaningful impact for patient outcomes, particularly those outside of the walls of the hospital," Jennifer Stevens, M.D., associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center and the study's lead author, said in an interview with the journal. 

Hospitalists treated patients in more than half (59.7%) of the studied admissions, while 14.2% were treated by their PCPs and 26.1% were treated by other generalists. 

Stevens said that studies like hers highlight the need for further research on the impacts and effectiveness of the hospitalist model, which has spread rapidly throughout the U.S. 

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The study's findings also offer key implications for primary care, wrote Lisa Willett, M.D., and C. Seth Landefeld, M.D., both of the University of Alabama at Birmingham, in an accompanying commentary in JAMA Internal Medicine. The results, they said, suggest that continued efforts to improve the inpatient-to-outpatient continuity care are worthwhile. 

"Recognizing the unique needs of each patient, including the patient's preferences, need for information, social support and the emotional and physical impact of illness, is the core of patient-centered care for which we strive," they wrote.