The impact of fragmentation of hospitalist care on length of stay.

Background: Different hospitalist staffing models provide different levels of inpatient continuity of care, which may impact length of stay (LOS).

Objective: To determine if fragmentation of care (FOC) by hospitalist physicians is associated with LOS.

Design: Concurrent control study.

Setting: Hospitalist practices managed by IPC The Hospitalist Company.

Patients: A total of 10,977 patients admitted for diagnosis-related group (DRG) of 89 pneumonia with complications or comorbidities (PNA) or a DRG of 127 heart failure and shock (HF) between December 2006 and November 2007.

Measurements: FOC was defined as the percentage of care given by hospitalists other than the hospitalist who saw the patient the majority of the stay. Negative binomial regression was performed on DRG 89 and DRG 127 patients with LOS as the dependent variable. We adjusted for gender, age, severity of illness (SOI) scores, risk of mortality (ROM) scores, and number of secondary diagnoses, and admission day of the week.

Results: A 10% increase in fragmentation was associated with an increase of 0.39 days (P < 0.0001) in the LOS for pneumonia, and an increase of 0.30 days (P < 0.0001) in LOS for heart failure.

Conclusions: As FOC increased for pneumonia and heart failure, the LOS increased significantly. Methods to reduce fragmentation should be explored, while more research is needed to identify the source of the relationship between FOC and LOS.