January 05, 2018
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First-year hospitalists have higher patient mortality rates

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Patients treated by first-year hospitalists have a greater risk for death than those seen by more experienced hospitalists, according to a study published in JAMA Internal Medicine.

“Substantial numbers of hospitalists are fresh graduates of residency training programs,” James S. Goodwin, MD, from the department of medicine at the University of Texas Medical Branch, and colleagues wrote. “Current data about the effect of hospitalist years of experience on patient outcomes are lacking.”

Goodwin and colleagues evaluated if hospitalist years of experience affects patient mortality using a 5% national sample of Medicare data. The researchers identified 21,612 hospitalists who were working from July 1, 2003, to June 30, 2014; of whom, 25% had 1 year of experience or less and 54% had 4 years of experience or more. They also identified 3,860 hospitalists who were in their first year between July 1, 2008, and June 30, 2011, and continued practice for at least 4 years.

Results showed that hospitalist experience and patient mortality were significantly associated. Patients cared for by first-year hospitalists had a 10.5% observed 30-day mortality, compared with 9.97% for those cared for by second-year hospitalists. The mortality odds were 0.9 (95% CI, 0.84-0.96) among patients of hospitalists in their second year, compared with patients of hospitalists in their first year.

Patients of first-year hospitalists also had a higher percentage of observed hospital mortality than patients of second-year hospitalists (3.33% vs. 2.96%; OR = 0.84; 95% CI, 0.75-0.95). The odds of mortality were similar between the second year and successive years of hospitalist experience for 30-day mortality and hospital mortality of patients.

“The worse outcomes for patients cared for by hospitalists in their first year of experience need further investigation into the factors that contribute to this finding,” Goodwin and colleagues concluded. “Many new hospitalists may experience dramatic change in their work environment after transitioning from residency... Our findings should prompt interventions to bolster support systems for new hospitalists such as mentoring or coaching programs. Additionally, medical education changes may have a role to play in mitigating the worse outcomes of first year hospitalists.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.