Table 3.
Use of Hospitalists and Office-Based Primary Care Physicians’ Number of Hospital Visits Per Week, by Primary Care Specialty
| Overall | General Internal Medicine | Family Practice | General Pediatrics | |||||
|---|---|---|---|---|---|---|---|---|
| IRR [95 % CI]* | p value | IRR [95 % CI]* | p value | IRR [95 % CI]* | p value | IRR [95 % CI]* | p value | |
| Percentage of hospitalized patients treated by a hospitalist | ||||||||
| 0 % | (ref) | (ref) | (ref) | (ref) | ||||
| 1–25 % (low) | 0.71 [0.59, 0.84] | < 0.001 | 0.57 [0.41, 0.80] | < 0.001 | 0.67 [0.47, 0.95] | 0.02 | 0.97 [0.70, 1.34] | 0.86 |
| 26–75 % (medium) | 0.42 [0.31, 0.58] | < 0.001 | 0.36 [0.22, 0.61] | < 0.001 | 0.33 [0.17, 0.64] | <0.001 | 0.49 [0.32, 0.75] | < 0.001 |
| 76–100 % (high) | 0.17 [0.13, 0.23] | < 0.001 | 0.11 [0.07, 0.19] | < 0.001 | 0.06 [0.04, 0.10] | <0.001 | 0.36 [0.24, 0.54] | < 0.001 |
| Physician characteristics | ||||||||
| Male | 1.46 [1.19, 1.78] | < 0.001 | 1.57 [1.15, 2.15] | 0.01 | 1.39 [0.97, 2.00] | 0.07 | 0.89 [0.67, 1.18] | 0.41 |
| White, non-Hispanic | 1.02 [0.77, 1.34] | 0.91 | 0.84 [0.58, 1.22] | 0.37 | 1.04 [0.65, 1.67] | 0.86 | 1.20 [0.83, 1.73] | 0.34 |
| International medical graduates | 1.02 [0.79, 1.31] | 0.88 | 0.96 [0.70, 1.33] | 0.81 | 0.81 [0.47, 1.39] | 0.44 | 0.97 [0.66, 1.45] | 0.90 |
| Years in practice | ||||||||
| 1–10 years | 1.18 [0.92, 1.51] | 0.19 | 1.27 [0.86, 1.87] | 0.23 | 0.67 [0.45, 1.02] | 0.06 | 1.21 [0.87, 1.67] | 0.25 |
| 11–20 years | 1.17 [0.93, 1.48] | 0.18 | 1.27 [0.89, 1.83] | 0.19 | 1.28 [0.86, 1.90] | 0.23 | 0.88 [0.62, 1.25] | 0.48 |
| 21+ years | (ref) | (ref) | (ref) | (ref) | ||||
| Time spent on email or phone conversation with other physicians a day | ||||||||
| 0–1 h | (ref) | (ref) | (ref) | (ref) | ||||
| 1+ hour | 1.34 [1.09, 1.65] | 0.01 | 1.49 [1.07, 2.07] | 0.02 | 1.14 [0.79, 1.63] | 0.49 | 1.03 [0.77, 1.37] | 0.84 |
| Compensation linked to productivity | 0.83 [0.66, 1.05] | 0.12 | 1.03 [0.72, 1.49] | 0.87 | 0.81 [0.53, 1.24] | 0.33 | 1.07 [0.79, 1.45] | 0.67 |
| Malpractice concern, agree/agree strongly | 0.98 [0.80, 1.19] | 0.84 | 1.19 [0.89, 1.59] | 0.25 | 0.92 [0.63, 1.32] | 0.64 | 1.01 [0.76, 1.33] | 0.97 |
| Percent of patients having chronic conditions | 1.00 [0.99, 1.00] | 0.33 | 1.00 [0.99, 1.01] | 0.81 | 1.01 [1.00, 1.02] | 0.11 | 0.99 [0.98, 1.00] | 0.14 |
| Practice characteristics | ||||||||
| Type | ||||||||
| Solo or 2 physicians | 1.04 [0.47, 2.29] | 0.93 | 0.69 [0.23, 2.11] | 0.52 | 1.10 [0.21, 5.81] | 0.91 | 2.28 [0.78, 6.61] | 0.13 |
| Group ≥ 3 physicians | 1.03 [0.47, 2.22] | 0.95 | 0.79 [0.27, 2.28] | 0.67 | 0.66 [0.13, 3.36] | 0.62 | 3.46 [1.26, 9.44] | 0.02 |
| HMO | (ref) | (ref) | (ref) | (ref) | ||||
| Medical school | 2.14 [0.71, 6.48] | 0.18 | 0.79 [0.20, 3.20] | 0.74 | 0.33 [0.05, 2.14] | 0.25 | 42.52 [7.61, 237.57] | < 0.001 |
| Hospital-based | 1.32 [0.51, 3.43] | 0.57 | 2.20 [0.59, 8.19] | 0.24 | 0.40 [0.07, 2.27] | 0.30 | 1.76 [0.40, 7.66] | 0.45 |
| Other | 0.39 [0.16, 0.93] | 0.04 | 0.25 [0.05, 1.32] | 0.10 | 0.30 [0.05, 1.73] | 0.18 | 2.44 [0.66, 9.03] | 0.18 |
| Size | ||||||||
| 1–100 physicians | (ref) | (ref) | (ref) | (ref) | ||||
| 101+ physicians | 0.93 [0.58, 1.50] | 0.76 | 0.73 [0.39, 1.38] | 0.33 | 0.49 [0.26, 0.94] | 0.03 | 1.02 [0.52, 1.98] | 0.96 |
| Use of IT | 1.03 [0.85, 1.25] | 0.75 | 1.22 [0.89, 1.67] | 0.22 | 1.04 [0.75, 1.45] | 0.80 | 1.18 [0.90, 1.55] | 0.22 |
| Source of practice revenue | ||||||||
| Percent from Medicare | 1.01 [1.01, 1.02] | < 0.001 | 1.02 [1.01, 1.03] | <0.001 | 1.01 [0.99, 1.02] | 0.24 | 1.01 [0.99, 1.02] | 0.38 |
| Percent from Medicaid | 1.01 [1.00, 1.02] | 0.002 | 1.01 [1.00, 1.03] | 0.12 | 1.01 [1.00, 1.03] | 0.05 | 1.00 [1.00, 1.01] | 0.72 |
| Percent from capitated or other prepaid basis | 1.00 [1.00, 1.01] | 0.28 | 1.00 [0.99, 1.01] | 0.43 | 1.00 [1.00, 1.01] | 0.32 | 1.00 [1.00, 1.01] | 0.47 |
| Market characteristics | ||||||||
| Geographic region | ||||||||
| Rural | 1.10 [0.83, 1.46] | 0.50 | 1.05 [0.64, 1.73] | 0.83 | 0.92 [0.59, 1.45] | 0.73 | 0.86 [0.54, 1.38] | 0.54 |
| HPSA | 1.05 [0.85, 1.29] | 0.65 | 0.78 [0.56, 1.10] | 0.16 | 1.20 [0.87, 1.64] | 0.27 | 1.62 [1.15, 2.27] | 0.01 |
| Socioeconomic | ||||||||
| Median household income, $ | 1.00 [1.00, 1.00] | 0.91 | 1.00 [1.00, 1.00] | 0.96 | 1.00 [1.00, 1.00] | 0.17 | 1.00 [1.00, 1.00] | 0.51 |
| Percent of uninsured | 1.02 [1.00, 1.04] | 0.04 | 1.02 [0.99, 1.05] | 0.23 | 1.00 [0.96, 1.03] | 0.86 | 1.03 [1.00, 1.07] | 0.04 |
| Population density, people/mi2 | 1.00 [1.00, 1.00] | 0.73 | 1.00 [1.00, 1.00] | 0.70 | 1.00 [1.00, 1.00] | 1.00 | 1.00 [1.00, 1.00] | 0.34 |
| Health care resources and utilization | ||||||||
| Total hospitalists per 100,000 population | 1.00 [0.98, 1.01] | 0.57 | 1.01 [0.99, 1.03] | 0.36 | 1.00 [0.95, 1.04] | 0.94 | 0.97 [0.95, 0.99] | 0.02 |
| Total admissions per 1,000 population | 1.00 [1.00, 1.00] | 0.73 | 1.00 [1.00, 1.00] | 0.87 | 1.00 [1.00, 1.00] | 0.83 | 1.00 [0.99, 1.00] | 0.05 |
| Total ED visits per 1,000 population | 1.00 [1.00, 1.00] | 0.41 | 1.00 [1.00, 1.00] | 0.69 | 1.00 [1.00, 1.00] | 0.31 | 1.00 [1.00, 1.00] | 0.20 |
| Total outpatient days per 1,000 population | 1.00 [1.00, 1.00] | 0.40 | 1.00 [1.00, 1.00] | 0.25 | 1.00 [1.00, 1.00] | 0.52 | 1.00 [1.00, 1.00] | 0.33 |
| Percent of Medicare managed care penetration | 1.01 [1.00, 1.02] | 0.10 | 1.01 [1.00, 1.02] | 0.08 | 1.01 [1.00, 1.03] | 0.13 | 1.01 [1.00, 1.02] | 0.20 |
*Results from a negative binomial regression
HMO health maintenance organization; IT information technology; HPSA health professional shortage area; ED emergency department