Dataset Information

Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System.

ABSTRACT:

Importance

Clinical experience suggests that there are substantial differences in patient complexity across medical specialties, but empirical data are lacking.

Objective

To compare the complexity of patients seen by different types of physician in a universal health care system.

Design, setting, and participants

Population-based retrospective cohort study of 2?597?127 residents of the Canadian province of Alberta aged 18 years and older with at least 1 physician visit between April 1, 2014 and March 31, 2015. Data were analyzed in September 2018.

Exposures

Type of physician seeing each patient (family physician, general internist, or 11 types of medical subspecialist) assessed as non-mutually exclusive categories.

Main outcomes and measures

Nine markers of patient complexity (number of comorbidities, presence of mental illness, number of types of physicians involved in each patient's care, number of physicians involved in each patient's care, number of prescribed medications, number of emergency department visits, rate of death, rate of hospitalization, rate of placement in a long-term care facility).

Results

Among the 2?597?127 participants, the median (interquartile range) age was 46 (32-59) years and 54.1% were female. Over 1 year of follow-up, 21?792 patients (0.8%) died, the median (range) number of days spent in the hospital was 0 (0-365), 8.1% of patients had at least 1 hospitalization, and the median (interquartile range) number of prescribed medications was 3 (1-7). When the complexity markers were considered individually, patients seen by nephrologists had the highest mean number of comorbidities (4.2; 95% CI, 4.2-4.3 vs [lowest] 1.1; 95% CI, 1.0-1.1), highest mean number of prescribed medications (14.2; 95% CI, 14.2-14.3 vs [lowest] 4.9; 95% CI, 4.9-4.9), highest rate of death (6.6%; 95% CI, 6.3%-6.9% vs [lowest] 0.1%; 95% CI, <0.1%-0.2%), and highest rate of placement in a long-term care facility (2.0%; 95% CI, 1.8%-2.2% vs [lowest] <0.1%; 95% CI, <0.1%-0.1%). Patients seen by infectious disease specialists had the highest complexity as assessed by the other 5 markers: rate of a mental health condition (29%; 95% CI, 28%-29% vs [lowest] 14%; 95% CI, 14%-14%), mean number of physician types (5.5; 95% CI, 5.5-5.6 vs [lowest] 2.1; 95% CI, 2.1-2.1), mean number of physicians (13.0; 95% CI, 12.9-13.1 vs [lowest] 3.8; 95% CI, 3.8-3.8), mean days in hospital (15.0; 95% CI, 14.9-15.0 vs [lowest] 0.4; 95% CI, 0.4-0.4), and mean emergency department visits (2.6; 95% CI, 2.6-2.6 vs [lowest] 0.5; 95% CI, 0.5-0.5). When types of physician were ranked according to patient complexity across all 9 markers, the order from most to least complex was nephrologist, infectious disease specialist, neurologist, respirologist, hematologist, rheumatologist, gastroenterologist, cardiologist, general internist, endocrinologist, allergist/immunologist, dermatologist, and family physician.

Conclusion and relevance

Substantial differences were found in 9 different markers of patient complexity across different types of physician, including medical subspecialists, general internists, and family physicians. These findings have implications for medical education and health policy.

SUBMITTER: Tonelli M

PROVIDER: S-EPMC6324421 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System.

Tonelli Marcello M Wiebe Natasha N Manns Braden J BJ Klarenbach Scott W SW James Matthew T MT Ravani Pietro P Pannu Neesh N Himmelfarb Jonathan J Hemmelgarn Brenda R BR

JAMA network open 20181102 7

<h4>Importance</h4>Clinical experience suggests that there are substantial differences in patient complexity across medical specialties, but empirical data are lacking.<h4>Objective</h4>To compare the complexity of patients seen by different types of physician in a universal health care system.<h4>Design, setting, and participants</h4>Population-based retrospective cohort study of 2 597 127 residents of the Canadian province of Alberta aged 18 years and older with at least 1 physician visit betw ...[more]

PMID: 30646392

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Dataset Information

Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System.

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Conclusion and relevance

Publications

Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System.

Similar Datasets

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