Table 4.
Patient 30 day readmission rates and costs of care between general internists who graduated from a medical school outside the US compared with graduates of a US medical school. Adjusted patient outcomes are percentages, unless stated otherwise
| Variables | No of hospital admissions (No of physicians) | Adjusted patient outcomes (95% CI) | Adjusted odds ratio/difference (95% CI) international v US graduates | P value | |
|---|---|---|---|---|---|
| International graduates | US graduates | ||||
| 30 day readmission rate: | |||||
| Model 1: risk adjusted 30 day readmissions* | 1 182 268 (44 201) | 15.9 (15.8 to 16.0) | 14.9 (14.8 to 15.0) | 1.08 (1.07 to 1.09) | <0.001 |
| Model 2: model 1+physician characteristics† | 1 149 716 (42 833) | 15.8 (15.7 to 15.9) | 15.0 (14.9 to 15.1) | 1.06 (1.05 to 1.07) | <0.001 |
| Model 3: model 2+hospital fixed effects‡ | 1 149 024 (42 667) | 15.4 (15.3 to 15.5) | 15.5 (15.4 to 15.6) | 1.00 (0.98 to 1.01) | 0.54 |
| Total part B costs per hospital admission: | |||||
| Model 1: risk adjusted costs per hospital admissions* | 1 276 559 (44 680) | $1192 ($1184 to $1201) | $1041 ($1034 to $1047) | $152 ($141 to $162) | <0.001 |
| Model 2: model 1+physician characteristics† | 1 240 872 (42 944) | $1195 ($1187 to $1203) | $1038 ($1031 to $1046) | $157 ($146 to $168) | <0.001 |
| Model 3: model 2+hospital fixed effects‡ | 1 240 867 (42 944) | $1145 ($1140 to $1150) | $1098 ($1093 to $1103) | $47 ($39 to $55) | <0.001 |
$1.00 (£0.83; €0.94).
*Risk adjustment using patients’ age, sex, race, primary diagnosis, coexisting conditions (Elixhauser comorbidity index), median household income, Medicaid status, year indicators, and day of week.
†Include age, sex, and patient volume.
‡Hospital fixed effects allowed an effective comparison of patient outcomes between international and US graduates within the same hospital.