Dataset Information

Physician age and outcomes in elderly patients in hospital in the US: observational study.

ABSTRACT: Objectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians.Design Observational study.Setting US acute care hospitals.Participants 20% random sample of Medicare fee-for-service beneficiaries aged ?65 admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. To assess the generalizability of findings, analyses also included patients treated by general internists including both hospitalists and non-hospitalists.Main outcome measures 30 day mortality and readmissions and costs of care. Results 736?537 admissions managed by 18?854 hospitalist physicians (median age 41) were included. Patients' characteristics were similar across physician ages. After adjustment for characteristics of patients and physicians and hospital fixed effects (effectively comparing physicians within the same hospital), patients' adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% confidence interval 10.7% to 10.9%), 11.1% for physicians aged 40-49 (11.0% to 11.3%), 11.3% for physicians aged 50-59 (11.1% to 11.5%), and 12.1% for physicians aged ?60 (11.6% to 12.5%). Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality. Readmissions did not vary with physician age, while costs of care were slightly higher among older physicians. Similar patterns were observed among general internists and in several sensitivity analyses.Conclusions Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients.

SUBMITTER: Tsugawa Y

PROVIDER: S-EPMC5431772 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Physician age and outcomes in elderly patients in hospital in the US: observational study.

Tsugawa Yusuke Y Newhouse Joseph P JP Zaslavsky Alan M AM Blumenthal Daniel M DM Jena Anupam B AB

BMJ (Clinical research ed.) 20170516

Objectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians.Design Observational study.Setting US acute care hospitals.Participants 20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. To assess the generalizability ...[more]

PMID: 28512089

Similar Datasets

Project description:The optimal staffing model for physicians in the ICU is unknown. Patient-to-intensivist ratios may offer a simple measure of workload and be associated with patient mortality and physician burnout. To evaluate the association of physician workload, as measured by the patient-to-intensivist ratio, with physician burnout and patient mortality.DesignCross-sectional observational study.SettingFourteen academic centers in the United States from August 2020 to July 2021.SubjectsWe enrolled ICU physicians and collected data on adult ICU patients under the physician's care on the single physician-selected study day for each physician.Measurements and main resultsThe primary exposure was workload (self-reported number of patients' physician was responsible for) modeled as high (>14 patients) and low (≤14 patients). The primary outcome was burnout, measured by the Well-Being Index. The secondary outcome measure was 28-day patient mortality. We calculated odds ratio for burnout and patient outcomes using a multivariable logistic regression model and a binomial mixed effects model, respectively. We enrolled 122 physicians from 62 ICUs. The median patient-to-intensivist ratio was 12 (interquartile range, 10-14), and the overall prevalence of burnout was 26.4% (n = 32). Intensivist workload was not independently associated with burnout (adjusted odds ratio, 0.74; 95% CI, 0.24-2.23). Of 1,322 patients, 679 (52%) were discharged alive from the hospital, 257 (19%) remained hospitalized, and 347 (26%) were deceased by day 28; 28-day outcomes were unknown for 39 of patients (3%). Intensivist workload was not independently associated with 28-day patient mortality (adjusted odds ratio, 1.33; 95% CI, 0.92-1.91).ConclusionsIn our cohort, approximately one in four physicians experienced burnout on the study day. There was no relationship be- tween workload as measured by patient-to-intensivist ratio and burnout. Factors other than the number of patients may be important drivers of burnout among ICU physicians.

Project description:Background Sarcopenia is a syndrome characterized by loss of muscle mass, strength and function. Frailty, a state of vulnerability with diminished reserves. The measurement of perioperative risk does not include the assessment of these variables, as little is known about how these conditions impact each other. Methods Observational study with a cross-sectional and a prospective cohort component. Elderly people over 60 years of age, able to walk and to independently perform activities of daily living were consecutively recruited in the preoperative period of non-emergency surgical procedures. Frailty was measured by the modified frailty index (mFI-11). Sarcopenia was measured by: (1) thickness and echogenicity on ultrasound; (2) handgrip strength on dynamometry and (3) gait speed. Data obtained from eight muscle groups were submitted to Principal Component Analysis. Postoperative complications were measured using the Clavien-Dindo scale. Follow-up was performed for 1 year to record readmissions and deaths. Results Between February and May 2019, 125 elderly people were recruited, median age of 71 years (IQR 65–77), 12% of whom were frail. Frailty was associated with older age, use of multiple medicines, presence of multimorbidity and greater surgical risk according to the American Society of Anesthesiologists (ASA) scale, in addition to lower gait speeds and lower handgrip strength. Frailty was also independently associated with smaller measurements of muscle thickness but not with echogenicity, and with longer hospital and Intensive care unit (ICU) stays. Prevalence of sarcopenia was 14% when considering at least two criteria: low walking speed and low handgrip strength. For muscle thickness, lower values were associated with female gender, older age, frailty, lower gait speeds and lower muscle strength, higher proportion of postoperative complications and higher occurrence of death. For echogenicity, higher values were related to the same factors as those of lower muscle thickness, except for postoperative complications. Lower gait speeds and lower handgrip strength were both associated with higher proportions of postoperative complications, and longer hospital stays. A higher mortality rate was observed in those with lower gait speeds. Conclusion Sarcopenia was associated with frailty in all its domains. Unfavorable surgical outcomes were also associated with these two conditions.

Project description:BackgroundThe COVID-19 pandemic has caused over 6 million deaths worldwide. The elderly accounted for a large proportion of patients with their mortality rate largely higher than the non-elderly. However, limited studies have explored clinical factors associated with poor clinical outcomes in this important population. Therefore, this study aimed to determine factors independently associated with adverse clinical outcomes among COVID-19 elderly patients.MethodsWe conducted a multicenter observational study at five emergency departments (EDs) in Thailand. Patients over 18 years old diagnosed with COVID-19 between January and December 2021 were included. We classified patients into elderly (age ≥ 65 years) and non-elderly (age < 65 years). The primary clinical outcome was in-hospital mortality. The secondary outcomes were endotracheal intubation and intensive care unit admission. We identified independent factors associating with these outcomes both in the whole population and separately by age group using multivariate logistic regression models.ResultsA total of 978 patients were included, 519 (53.1%) were elderly and 459 (46.9%) were non-elderly, and 254 (26%) died at hospital discharge. The mortality rate was significantly higher in the elderly group (39.1% versus 14.3%, p<0.001)). In the elderly, age (adjusted odds ratio (aOR) 1.13; 95% confidence interval (CI) 1.1-1.2; p<0.001), male sex (aOR 3.64; 95%CI 1.5-8.8; p=0.004), do-not-resuscitate (DNR) status (aOR 12.46; 95%CI 3.8-40.7; p<0.001), diastolic blood pressure (aOR 0.96; 95%CI 0.9-1.0; p=0.002), body temperature (aOR 1.74; 95%CI 1.0-2.9; p=0.036), and Glasgow Coma Scale (GCS) score (aOR 0.71; 95%CI 0.5-1.0; p=0.026) were independent baseline and physiologic factors associated with in-hospital mortality. Only DNR status and GCS score were associated with in-hospital mortality in both the elderly and non-elderly, as well as the overall population. Lower total bilirubin was independently associated with in-hospital mortality in the elderly (aOR 0.34; 95%CI 0.1-0.9; p=0.035), while a higher level was associated with the outcome in the non-elderly. C-reactive protein (CRP) was the only laboratory factor independently associated with all three study outcomes in the elderly (aOR for in-hospital mortality 1.01; 95%CI 1.0-1.0; p=0.006).ConclusionImportant clinical factors associated with in-hospital mortality in elderly COVID-19 patients were age, sex, DNR status, diastolic blood pressure, body temperature, GCS score, total bilirubin, and CRP. These parameters may aid in triage and ED disposition decision-making in this very important patient population during times of limited resources during the COVID-19 pandemic.

Project description:BackgroundRecent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data.ObjectiveTo measure the association between physician-hospital integration and both spending and quality using patient-level data and explicit physician-hospital contracting information.DesignRetrospective review of claims data from 2014 through 2016. Adjustments were made for patient, physician, and regional characteristics.PatientsPatients aged 19 to 64 enrolled in a Blue Cross Blue Shield Texas Preferred Provider Organization in the four largest metropolitan areas in Texas who could be attributed to a physician practice based on claims.Main outcomes and measuresAnnual spending per patient was compared for patients treated by a physician practice that is billing through a hospital, versus billing through an independent physician practice; spending was also subdivided by BETOS category, by site and type of care, and percent of patients with positive spending by subcategory. Quality measures included readmission within 30 days of discharge for hospitalized patients, appropriate care for diabetic patients, and screening mammography for women ages 50-64.ResultsEstimates suggest that patients in a preferred provider organization incur spending which is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices (95% CI 1.7 to 9.9; p = 0.006). Spending is significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care. The spending difference appears attributable to greater service utilization rather than higher prices. There was no consistent difference in care quality for hospital-owned versus physician-owned practices.Conclusions and relevanceWe find that financial integration between physicians and hospitals raises patient spending, but not care quality. Given that higher spending raises the price of health insurance, policy makers should carefully consider policies that limit consolidation of hospitals and physicians.

Project description:BackgroundRenal replacement therapy (RRT) in critically ill patients is associated with high morbidity and mortality. The appropriateness of RRT initiation is sometimes questioned in elderly patients. Therefore, we sought to evaluate the long-term mortality, dialysis dependence and quality of life (QOL) of elderly patients who survived critical illness requiring RRT.MethodsThis is a monocentric observational study including all patients > 55 yo who received RRT for acute kidney injury in our intensive care unit (ICU) between January 2015 and April 2018. At the time of the study (May 2019), we assessed if they were still alive by cross referencing our hospital database and the Swiss national death registry. We sent survivors written information and, subsequently, contacted them over the phone. We obtained their consent for participation, asked about their dialytic status and performed an EQ-5D survey with visual analog scale (VAS). Results were stratified according to their age at the time of ICU admission (G1: "55-65 yo"; G2: "> 65-75 yo" and G3: "> 75 yo"). QOL in G3 patients were compared to G1 and G2 and to predicted values.ResultsAmong the 352 eligible patients, 171 died during the index hospital admission. After a median follow-up time of 32.7 months (IQR 19.8), a further 62 had died (median time to death for ICU survivors 5.0 (IQR 15.0) months. Hence, 119 (33.6%) patients were still alive at the time of the study. We successfully contacted 96 (80.7%) of them and 83 (69.7%) were included in the study (G1: 24, G2: 44 and G3: 15). Only 6 (7.2%) were RRT dependent. Patients in G3 had lower EQ-5D and VAS scores than those in G1 and G2 (p < 0.01). These scores were also significantly lower than predicted values (p < 0.05).ConclusionsRRT patients have a very high in-hospital and post discharge mortality. Among survivors, RRT dependency was low. Irrespective of baseline values, patients > 75 yo who survived ICU had a lower QOL than younger patients. It was lower than predicted according to age and sex. The appropriateness of RRT initiation in elderly patients should be discussed according to their pre-existing QOL and frailty.

Project description:BackgroundCancer is mostly a disease of aging, and older patients with cancer are generally frailer. This study aimed to describe the characteristics and in-hospital outcomes and explore factors associated with duration, cost, and mortality during first hospitalization, in older patients with cancer admitted to a top-ranked hospital in China.MethodsData on patients with solid cancer ≥65 years consecutively hospitalized in 2016-2020 were retrieved from the electronic medical records of Ruijin Hospital in Shanghai, China. Baseline characteristics, duration, cost, and mortality during hospitalization were described. Factors associated with duration, cost, and mortality during first hospitalization were explored using multivariable-adjusted logistic regression.Results20,650 eligible patients with male proportion of 59% and median age of 70 years were analyzed. 45% of the patients underwent resection in our hospital. Upon first admission, 49% of patients had hypertension, 19% diabetes, 22% weight loss, and 28% risks of malnutrition. The median duration and cost of first hospitalization were 9 days and 32,000 RMB, respectively. 118 (0.6%) and 228 (1.1%) deaths occurred during first and any hospitalization, respectively. For first hospitalization, longer duration and higher cost were positively associated with older ages, male gender, emergency admission, certain tumor locations and histology, histories of diabetes, cirrhosis, and anticoagulant intake, higher body mass index, weight loss, reduced food intake, risk of falling, and worse self-care ability; in-hospital mortality was positively associated with age ≥85 years, emergency admission, certain cancer types, histories of hypertension and psychotropic intake, reduced food intake, and worse self-care ability.ConclusionsThis study identified certain baseline patient and tumor characteristics, medical and medication histories, changes of weight and food intake, diet, and self-care ability which were independently associated with in-hospital outcomes among older patients with cancer admitted to our hospital and which should be paid special attention to. While the factors might not be easily modifiable, our study can help identify patients at higher risks of inferior in-hospital outcomes.

Dataset Information

Physician age and outcomes in elderly patients in hospital in the US: observational study.

Publications

Physician age and outcomes in elderly patients in hospital in the US: observational study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets