Increased number of family physicians reduced hospital readmission rates

Chetty VK. Am Fam Physician. 2011;83:1054.

Researchers from the Boston University School of Medicine and Boston Medical Center have found that by adding one family physician per 1,000 population, or 100 per 100,000, hospital readmission costs may be reduced by $579 million annually.

The findings, published recently in American Family Physician, noted that the $579 million in potential savings would account for 83% of the target set by the Patient Protection and Affordable Care Act.

The researchers used data from the Hospital Compare database, which included readmission rates for pneumonia, heart attack and heart failure, for 4,459 hospitals as well as the Area Source File that contains data for physicians per population at the county level, according to a press release.

“Using these data, we found that 30-day readmission rates for all three diagnoses decrease as the number of family physicians increases,” Brian Jack, MD, associate professor and vice-chair for academic affairs in the department of family medicine at Boston University School of Medicine, said in the release. “Conversely, increased numbers of physicians in all other major specialties, including general internal medicine, is associated with increased risk of readmission.”

The study noted that pneumonia, heart attack and heart failure accounted for a combined 15.7% of all readmissions in 2005. These readmissions, the study reported, numbered 74,419 for pneumonia, 20,866 for heart attacks, and 90,723 for heart failure. Corresponding Medicare expenditures were reported at $533 million, $136 million, and $590 million, respectively.

“Data show that 30-day readmission rates for these diagnoses decrease as the number of [family physicians] increases,” the researchers wrote.

Adjusting for mortality, sociodemographics and hospital characteristics, the reserachers reported that adding one family physician per 1,000 population reduced readmission odds for the three conditions by 7%, 5%, and 8%, respectively. One cited workforce study suggested an estimated 46 family physicians be added per 100,000 populations — a number the researchers wrote: “could reduce readmission costs by $81 million per year.”

“Hospital readmission after discharge is often a costly failing of the US health care system to adequately manage patients who are ill,” they wrote in the study abstract, adding that timely management of recovering patients in primary care could potentially reduce readmission. “Increasing the numbers of family physicians is associated with significant reductions in hospital readmissions and substantial cost savings.”

Disclosure: The researchers report no relevant financial disclosures.

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