Table 2.
Factors Associated with Being in the Highest Hospitalist Group, by Primary Care Specialty
| Overall | General Internal Medicine | Family Practice | General Pediatrics | |||||
|---|---|---|---|---|---|---|---|---|
| OR [95 % CI]* | p value | OR [95 % CI]* | p value | OR [95 % CI]* | p value | OR [95 % CI]* | p value | |
| Physician characteristics | ||||||||
| Male | 0.79 [0.62, 1.02] | 0.08 | 0.64 [0.38, 1.08] | 0.09 | 0.80 [0.50, 1.27] | 0.34 | 0.75 [0.45, 1.24] | 0.26 |
| White, non-Hispanic | 0.97 [0.72, 1.30] | 0.83 | 0.72 [0.44, 1.18] | 0.20 | 1.94 [1.02, 3.67] | 0.04 | 0.73 [0.40, 1.32] | 0.29 |
| International medical graduates | 0.56 [0.41, 0.77] | < 0.001 | 0.64 [0.39, 1.03] | 0.07 | 0.91 [0.45, 1.85] | 0.80 | 0.47 [0.23, 0.96] | 0.04 |
| Years in practice | ||||||||
| 1–10 years | 0.63 [0.47, 0.83] | < 0.001 | 0.59 [0.33, 1.06] | 0.08 | 0.60 [0.38, 0.97] | 0.04 | 0.72 [0.39, 1.33] | 0.30 |
| 11–20 years | 0.84 [0.63, 1.11] | 0.21 | 0.74 [0.44, 1.25] | 0.26 | 0.83 [0.51, 1.36] | 0.46 | 1.10 [0.63, 1.93] | 0.74 |
| 21+ years | (ref) | (ref) | (ref) | (ref) | ||||
| Time spent on email or phone conversation with other physicians per day | ||||||||
| 0–1 h | (ref) | (ref) | (ref) | (ref) | ||||
| 1+ h | 0.78 [0.62, 0.99] | 0.04 | 1.20 [0.78, 1.84] | 0.41 | 0.64 [0.42, 0.97] | 0.04 | 0.68 [0.41, 1.13] | 0.14 |
| Compensation linked to productivity | 1.07 [0.83, 1.38] | 0.61 | 0.91 [0.57, 1.45] | 0.69 | 1.16 [0.72, 1.85] | 0.55 | 0.94 [0.55, 1.62] | 0.84 |
| Malpractice concern, agree/agree strongly | 1.17 [0.93, 1.47] | 0.19 | 1.23 [0.78, 1.95] | 0.37 | 1.03 [0.69, 1.55] | 0.87 | 1.01 [0.65, 1.59] | 0.95 |
| Percent of patients having chronic conditions | 1.01 [1.00, 1.01] | 0.01 | 1.00 [0.98, 1.01] | 0.54 | 1.01 [1.00, 1.02] | 0.07 | 1.00 [0.98, 1.02] | 0.96 |
| Practice characteristics | ||||||||
| Type | ||||||||
| Solo or 2 physicians | 0.64 [0.31, 1.31] | 0.22 | 0.35 [0.10, 1.18] | 0.09 | 0.89 [0.24, 3.30] | 0.86 | 0.75 [0.12, 4.70] | 0.76 |
| Group ≥ 3 physicians | 0.66 [0.33, 1.31] | 0.23 | 0.60 [0.18, 1.95] | 0.39 | 0.75 [0.22, 2.57] | 0.64 | 0.67 [0.11, 3.98] | 0.66 |
| HMO | (ref) | (ref) | (ref) | (ref) | ||||
| Medical school | 0.39 [0.17, 0.88] | 0.02 | 0.52 [0.14, 1.87] | 0.32 | 0.12 [0.02, 0.62] | 0.01 | 0.93 [0.07, 12.30] | 0.95 |
| Hospital-based | 0.94 [0.41, 2.16] | 0.89 | 1.07 [0.23, 5.07] | 0.93 | 0.79 [0.17, 3.76] | 0.77 | 1.41 [0.20, 10.11] | 0.73 |
| Other | 0.55 [0.24, 1.28] | 0.17 | 0.41 [0.08, 2.10] | 0.28 | 0.73 [0.17, 3.05] | 0.66 | 0.62 [0.09, 4.50] | 0.64 |
| Size | ||||||||
| 1–100 physicians | (ref) | (ref) | (ref) | (ref) | ||||
| 101+ physicians | 2.08 [1.35, 3.20] | < 0.001 | 3.47 [1.67, 7.22] | < 0.001 | 1.34 [0.63, 2.84] | 0.45 | 2.46 [0.98, 6.18] | 0.06 |
| Use of IT | 0.97 [0.77, 1.23] | 0.81 | 1.16 [0.75, 1.80] | 0.51 | 0.86 [0.58, 1.27] | 0.44 | 0.86 [0.52, 1.43] | 0.57 |
| Source of practice revenue | ||||||||
| Percent from Medicare | 0.99 [0.99, 1.00] | 0.05 | 0.99 [0.98, 1.00] | 0.19 | 0.99 [0.98, 1.01] | 0.26 | 1.00 [0.98, 1.02] | 0.96 |
| Percent from Medicaid | 1.00 [1.00, 1.01] | 0.56 | 1.01 [1.00, 1.02] | 0.19 | 0.99 [0.98, 1.01] | 0.22 | 1.01 [0.99, 1.02] | 0.38 |
| Percent from capitated or other prepaid basis | 1.00 [1.00, 1.01] | 0.10 | 1.00 [0.99, 1.01] | 0.87 | 1.01 [1.00, 1.02] | 0.01 | 1.00 [0.99, 1.01] | 0.94 |
| Market characteristics | ||||||||
| Geographic region | ||||||||
| Rural | 0.60 [0.41, 0.87] | 0.01 | 1.29 [0.58, 2.87] | 0.54 | 0.33 [0.19, 0.59] | < 0.001 | 0.62 [0.23, 1.69] | 0.35 |
| HPSA | 1.22 [0.96, 1.56] | 0.11 | 1.40 [0.85, 2.28] | 0.18 | 1.05 [0.70, 1.58] | 0.82 | 1.26 [0.74, 2.17] | 0.40 |
| Socioeconomic | ||||||||
| Median household income, $ | 1.00 [1.00, 1.00] | < 0.001 | 1.00 [1.00, 1.00] | 0.03 | 1.00 [1.00, 1.00] | 0.16 | 1.00 [1.00, 1.00] | < 0.001 |
| Percent of uninsured | 1.04 [1.02, 1.07] | < 0.001 | 1.01 [0.96, 1.05] | 0.73 | 1.02 [0.98, 1.07] | 0.24 | 1.06 [1.00, 1.12] | 0.04 |
| Population density, people/mi2 | 1.00 [1.00, 1.00] | 0.35 | 1.00 [1.00, 1.00] | 0.64 | 1.00 [1.00, 1.00] | 0.77 | 1.00 [1.00, 1.00] | 0.51 |
| Health care resources and utilization | ||||||||
| Total hospitalists per 100,000 population | 1.04 [1.02, 1.07] | 0.002 | 1.04 [1.00, 1.09] | 0.05 | 1.05 [1.00, 1.11] | 0.06 | 1.03 [0.99, 1.07] | 0.13 |
| Total admissions per 1,000 population | 1.00 [1.00, 1.00] | 0.77 | 1.00 [0.99, 1.01] | 0.93 | 1.00 [1.00, 1.00] | 0.97 | 1.00 [1.00, 1.01] | 0.54 |
| Total ED visits per 1,000 population | 1.00 [1.00, 1.00] | 0.73 | 1.00 [1.00, 1.00] | 0.34 | 1.00 [1.00, 1.00] | 0.63 | 1.00 [1.00, 1.00] | 0.82 |
| Total outpatient days per 1,000 population | 1.00 [1.00, 1.00] | 0.34 | 1.00 [1.00, 1.00] | 0.57 | 1.00 [1.00, 1.00] | 0.77 | 1.00 [1.00, 1.00] | 0.90 |
| Percent of Medicare managed care penetration | 1.02 [1.01, 1.03] | < 0.001 | 1.03 [1.01, 1.05] | < 0.001 | 1.01 [0.99, 1.03] | 0.30 | 1.02 [1.00, 1.04] | 0.03 |
*Results from an ordered logistic regression. Our response variable, use of hospitalists, was treated as ordinal under the assumption that the levels of hospitalist use (percentage of hospitalized patients treated by a hospitalist) have a natural ordering—i.e., 0 % (none), 1–25 % (low), 26–75 % (medium), and 76–100 % (high)
HMO health maintenance organization; IT information technology; HPSA health professional shortage area; ED emergency department