JAMA released a theme issue today, and the spotlight shines on readmissions. I will weigh in on the findings shortly as the issue contains a good deal of material. However, our own Mark Williams writes the featured commentary and I will let him cue the release:
The findings from these 3 reports also illustrate what experienced hospitalists, emergency physicians, and perhaps other physicians clearly recognize—the increasing fragmentation of patient care and consequent inappropriate use. Lack of coordinated care transitions has affected patients in the United States for half a century,12 but individual patients now see an increasing number of physicians, increasing the possibility of medical error, duplication of services, reduced quality, and increased cost. This has likely been driven, at least in part, by the marked expansion in the number of subspecialists, who now outnumber primary care physicians by about 2 to 1.13 Medicare beneficiaries and their families must navigate seeing a median of 2 primary care physicians and 5 specialists during a 2-year period, and about one-third change their assigned physician from one year to another.14 This fragmentation escalates as patients approach the end of their lives with numerous physicians involved in a patient’s care. A study of some of the “best” hospitals in the United States showed that 17% to 59% of patients saw 10 or more physicians during their last 6 months of life and averaged almost a month (27 days) in the hospital.15
Time to dig in….