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From the primary care clinic to the inpatient department and back: Continuity of care and providers
Researchers: Leonid Barksi1, Jacob Dreiher1, Shlomi Codish1, Miriam Kudisz Ovnat2
- Soroka Medical Center
- Clalit Health Services
Background: Currently, when patients are admitted to internal medicine departments, the staff of the primary care clinic has no feedback or an effective impact on the course of admission. No interventions were found to be effective at decreasing readmissions.
Objectives: To evaluate the effectiveness of an intervention to improve communication between an internal medicine department and a primary care clinic in terms of quality of care, patient and staff satisfaction.
Method: As of June 2014 patients from Primary Care Clinic "E" in Beer Sheva are admitted to Internal Medicine "F". Communication between the clinic and the department was improved. The study included all patients from Clinic E admitted to Internal Medicine F during June 2015-December 2016. Outcomes included readmissions, time to the first primary care visit, patient's experience and staff satisfaction. Data compared to two comparison groups: patients from Clinic "E" (January 2013-May 2014) and concurrent admission from Clinic "A" in Beer Sheva which has similar characteristics. Patients' characteristics were compared using univariate and multivariate models.
Findings: During the study period 217 patients of clinic "E" were admitted to ward "F" while 351 clinics "A" patients were admitted to all internal medicine wards. The historical cohort included admissions of 396 patients of clinic "E" to all wards. Readmission rate in one week was 5.9% in the intervention group, 8.0% in historical cohort, and 7.3% in the concurrent clinic "A" cohort. During one month, proportions were 15.9%, 20.5%, and 20.9% respectively. In multivariate analysis, the readmission rate in one week was higher in the historic cohort of clinic "E" compared to the intervention group (OR=2.77 95% CI 1.73-4.44 P<0.001) adjusted for age and sex.
Findings: During the study period 217 patients of clinic "E" were admitted to ward "F" while 351 clinics "A" patients were admitted to all internal medicine wards. The historical cohort included admissions of 396 patients of clinic "E" to all wards. Readmission rate in one week was 5.9% in the intervention group, 8.0% in historical cohort, and 7.3% in the concurrent clinic "A" cohort. During one month, proportions were 15.9%, 20.5%, and 20.9% respectively. In multivariate analysis, the readmission rate in one week was higher in the historic cohort of clinic "E" compared to the intervention group (OR=2.77 95% CI 1.73-4.44 P<0.001) adjusted for age and sex.
Recommendations: The study can identify the optimal model for admitting patients to internal medicine departments, which might be implemented in other hospitals.
Research number: R/44/2015
Research end date: 02/2019