使用临床实践数据定义住院医师:安大略省医生的系统级试点研究。

Open medicine : a peer-reviewed, independent, open-access journal Pub Date : 2013-09-17 eCollection Date: 2013-01-01
Heather L White, Thérèse A Stukel, Walter P Wodchis, Richard H Glazier
{"title":"使用临床实践数据定义住院医师:安大略省医生的系统级试点研究。","authors":"Heather L White,&nbsp;Thérèse A Stukel,&nbsp;Walter P Wodchis,&nbsp;Richard H Glazier","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hospitalists have become dominant providers of inpatient care in many North American hospitals. Despite the global growth of hospital medicine, no objective method has been proposed for defining the hospitalist discipline and delineating among inpatient practices on the basis of physicians' clinical volumes. We propose a functional method of identifying hospital-based physicians using aggregated measures of inpatient volume and apply this method to a retrospective, population-based cohort to describe the growth of the hospitalist movement, as well as the prevalence and practice characteristics of hospital-based generalists in one Canadian province.</p><p><strong>Methods: </strong>We used human resource databases and financial insurance claims to identify all active fee-for-service physicians working in Ontario, Canada, between fiscal year 1996/1997 and fiscal year 2010/2011. We constructed 3 measures of inpatient volume from the insurance claims to reflect the time that physicians spent delivering inpatient care in each fiscal year. We then examined how inpatient volumes have changed for Ontario physicians over time and described the prevalence of full-time and part-time hospital-based generalists working in acute care hospitals in fiscal year 2010/2011.</p><p><strong>Results: </strong>Our analyses showed a significant increase since fiscal year 2000/2001 in the number of high-volume hospital-based family physicians practising in Ontario (p < 0.001) and associated decreases in the numbers of high-volume internists and specialists (p = 0.03), where high volume was defined as ≥ 2000 inpatient services/ year. We estimated that 620 full-time and 520 part-time hospital-based physicians were working in Ontario hospitals in 2010/2011, accounting for 4.5% of the active physician workforce (n = 25 434). Hospital-based generalists, consisting of 207 family physicians and 130 general internists, were prevalent in all geographic regions and hospital types and collectively delivered 10% of all inpatient evaluation and care coordination for Ontario residents who had been admitted to hospital.</p><p><strong>Interpretation: </strong>These analyses confirmed a substantial increase in the prevalence of general hospitalists in Ontario from 1996 to 2011. Systems-level analyses of clinical practice data represent a practical and valid method for defining and identifying hospital-based physicians.</p>","PeriodicalId":88624,"journal":{"name":"Open medicine : a peer-reviewed, independent, open-access journal","volume":"7 3","pages":"e74-84"},"PeriodicalIF":0.0000,"publicationDate":"2013-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/81/71/OpenMed-07-74.PMC4161497.pdf","citationCount":"0","resultStr":"{\"title\":\"Defining hospitalist physicians using clinical practice data: a systems-level pilot study of Ontario physicians.\",\"authors\":\"Heather L White,&nbsp;Thérèse A Stukel,&nbsp;Walter P Wodchis,&nbsp;Richard H Glazier\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Hospitalists have become dominant providers of inpatient care in many North American hospitals. Despite the global growth of hospital medicine, no objective method has been proposed for defining the hospitalist discipline and delineating among inpatient practices on the basis of physicians' clinical volumes. We propose a functional method of identifying hospital-based physicians using aggregated measures of inpatient volume and apply this method to a retrospective, population-based cohort to describe the growth of the hospitalist movement, as well as the prevalence and practice characteristics of hospital-based generalists in one Canadian province.</p><p><strong>Methods: </strong>We used human resource databases and financial insurance claims to identify all active fee-for-service physicians working in Ontario, Canada, between fiscal year 1996/1997 and fiscal year 2010/2011. We constructed 3 measures of inpatient volume from the insurance claims to reflect the time that physicians spent delivering inpatient care in each fiscal year. We then examined how inpatient volumes have changed for Ontario physicians over time and described the prevalence of full-time and part-time hospital-based generalists working in acute care hospitals in fiscal year 2010/2011.</p><p><strong>Results: </strong>Our analyses showed a significant increase since fiscal year 2000/2001 in the number of high-volume hospital-based family physicians practising in Ontario (p < 0.001) and associated decreases in the numbers of high-volume internists and specialists (p = 0.03), where high volume was defined as ≥ 2000 inpatient services/ year. We estimated that 620 full-time and 520 part-time hospital-based physicians were working in Ontario hospitals in 2010/2011, accounting for 4.5% of the active physician workforce (n = 25 434). Hospital-based generalists, consisting of 207 family physicians and 130 general internists, were prevalent in all geographic regions and hospital types and collectively delivered 10% of all inpatient evaluation and care coordination for Ontario residents who had been admitted to hospital.</p><p><strong>Interpretation: </strong>These analyses confirmed a substantial increase in the prevalence of general hospitalists in Ontario from 1996 to 2011. Systems-level analyses of clinical practice data represent a practical and valid method for defining and identifying hospital-based physicians.</p>\",\"PeriodicalId\":88624,\"journal\":{\"name\":\"Open medicine : a peer-reviewed, independent, open-access journal\",\"volume\":\"7 3\",\"pages\":\"e74-84\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2013-09-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/81/71/OpenMed-07-74.PMC4161497.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open medicine : a peer-reviewed, independent, open-access journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2013/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open medicine : a peer-reviewed, independent, open-access journal","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2013/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

背景:在许多北美医院,住院医师已成为住院护理的主要提供者。尽管医院医学在全球范围内增长,但没有提出客观的方法来定义医院医师学科,并根据医生的临床量在住院实践中进行划分。我们提出了一种功能性方法,利用住院病人数量的汇总测量来识别医院医生,并将这种方法应用于一个回顾性的、基于人群的队列,以描述医院医生运动的增长,以及加拿大一个省医院全科医生的流行程度和实践特征。方法:我们使用人力资源数据库和金融保险索赔来确定1996/1997财政年度至2010/2011财政年度在加拿大安大略省工作的所有在职收费医生。我们从保险索赔中构建了住院病人数量的3个度量,以反映医生在每个财政年度提供住院病人护理所花费的时间。然后,我们研究了安大略省医生住院人数随时间的变化情况,并描述了2010/2011财政年度在急症护理医院工作的全职和兼职医院全科医生的流行情况。结果:我们的分析显示,自2000/2001财政年度以来,安大略省在医院执业的大量家庭医生的数量显著增加(p < 0.001),而大量内科医生和专科医生的数量相应减少(p = 0.03),其中大量被定义为≥2000住院服务/年。我们估计,2010/2011年安大略省医院有620名全职医生和520名兼职医院医生,占在职医生劳动力的4.5% (n = 25434)。以医院为基础的全科医生,包括207名家庭医生和130名普通内科医生,在所有地理区域和医院类型中都很普遍,他们共同为安大略省住院居民提供了10%的住院病人评估和护理协调。解释:这些分析证实,从1996年到2011年,安大略省普通医院的患病率大幅增加。临床实践数据的系统级分析是定义和识别医院医生的一种实用有效的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

摘要图片

摘要图片

分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Defining hospitalist physicians using clinical practice data: a systems-level pilot study of Ontario physicians.

Background: Hospitalists have become dominant providers of inpatient care in many North American hospitals. Despite the global growth of hospital medicine, no objective method has been proposed for defining the hospitalist discipline and delineating among inpatient practices on the basis of physicians' clinical volumes. We propose a functional method of identifying hospital-based physicians using aggregated measures of inpatient volume and apply this method to a retrospective, population-based cohort to describe the growth of the hospitalist movement, as well as the prevalence and practice characteristics of hospital-based generalists in one Canadian province.

Methods: We used human resource databases and financial insurance claims to identify all active fee-for-service physicians working in Ontario, Canada, between fiscal year 1996/1997 and fiscal year 2010/2011. We constructed 3 measures of inpatient volume from the insurance claims to reflect the time that physicians spent delivering inpatient care in each fiscal year. We then examined how inpatient volumes have changed for Ontario physicians over time and described the prevalence of full-time and part-time hospital-based generalists working in acute care hospitals in fiscal year 2010/2011.

Results: Our analyses showed a significant increase since fiscal year 2000/2001 in the number of high-volume hospital-based family physicians practising in Ontario (p < 0.001) and associated decreases in the numbers of high-volume internists and specialists (p = 0.03), where high volume was defined as ≥ 2000 inpatient services/ year. We estimated that 620 full-time and 520 part-time hospital-based physicians were working in Ontario hospitals in 2010/2011, accounting for 4.5% of the active physician workforce (n = 25 434). Hospital-based generalists, consisting of 207 family physicians and 130 general internists, were prevalent in all geographic regions and hospital types and collectively delivered 10% of all inpatient evaluation and care coordination for Ontario residents who had been admitted to hospital.

Interpretation: These analyses confirmed a substantial increase in the prevalence of general hospitalists in Ontario from 1996 to 2011. Systems-level analyses of clinical practice data represent a practical and valid method for defining and identifying hospital-based physicians.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Closing Open Medicine. Use of mental health care for nonpsychotic conditions by immigrants in different admission classes and by refugees in Ontario, Canada. Comparison of sampling methods for hard-to-reach francophone populations: yield and adequacy of advertisement and respondent-driven sampling. Pan-Canadian overpricing of medicines: a 6-country study of cost control for generic medicines. Dengue fever: a Wikipedia clinical review.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1