Association of Inpatient Continuity of Care with Complications and Length of Stay among Hospitalized Medicare Enrollees

James S. Goodwin, Shuang Li, Erin Hommel, Ann B. Nattinger, Yong Fang Kuo, Mukaila Raji

Research output: Contribution to journalArticlepeer-review


Importance: Continuity in primary care is associated with improved outcomes, but less information is available on the association of continuity of care in the hospital with hospital complications. Objective: To assess whether the number of hospitalists providing care is associated with subsequent hospital complications and length of stay. Design, Setting, and Participants: This retrospective cohort study used multilevel logistic regression models to analyze Medicare claims for medical admissions from 2016 to 2018 with a length of stay longer than 4 days. Admissions with multiple charges on the same day from a hospitalist or an intensive care unit (ICU) stay during hospital days 1 to 3 were excluded. The data were accessed and analyzed from November 1, 2020, to April 30, 2021. Exposures: The number of different hospitalists who submitted charges during hospital days 1 to 3. Main Outcomes and Measures: Overall length of stay and transfer to ICU or a new diagnosis of drug toxic effects on hospital day 4 or later. Results: Among the 617680 admissions, 362376 (58.7%) were women, with a mean (SD) age of 80.2 (8.4) years. In 306037 admissions (49.6%), the same hospitalist provided care on days 1 to 3, while 2 hospitalists provided care in 274658 admissions (44.5%), and 3 hospitalists provided care in 36985 admissions (6.0%). There was no significant association between the number of different hospitalists on days 1 to 3 and either length of stay or subsequent ICU transfers. Admissions seeing 2 or 3 hospitalists had a slightly greater adjusted odds of subsequent new diagnoses of drug toxic effects (2 hospitalists: odds ratio [OR], 1.04; 95% CI, 1.02-1.07; 3 hospitalists: OR, 1.07; 95% CI, 1.03-1.12). Conclusions and Relevance: There was little evidence that receiving care from multiple hospitalists was associated with worse outcomes for patients receiving all their general medical care from hospitalists.

Original languageEnglish (US)
Article numbere2120622
JournalJAMA network open
Issue number8
StatePublished - Aug 12 2021

ASJC Scopus subject areas

  • General Medicine


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