Translate AMICOR contents if you like

Wednesday, May 17, 2017

Older physicians

Diana Swift
May 16, 2017
The sample comprised 736,537 admissions to US acute-care hospitals managed by 18,854 hospitalists. The median age of physicians was 41 years, with 10,177 physicians younger than 40 years, 8016 aged from 40 to 49 years, 3331 aged from 50 to 59 years, and 1086 aged 60 years and older.
The characteristics of the patients were comparable across physician age groups, with a mean age of approximately 80.5 years, 60% women, and approximately 83% white.
Overall 30-day mortality rate was 11.1%. After adjustment for patient and physician characteristics and hospital-specific fixed effects, the adjusted 30-day mortality rates across the four age categories were as follows: 10.8% for physicians younger than 40 years (95% confidence interval [CI], 10.7% - 10.9%), 11.1% for those aged 40 to 49 years (95% CI, 11.0% - 11.3%), 11.3% for those aged 50 to 59 years (95% CI, 11.1 - 11.5), and 12.1% for those aged 60 years and older (95% CI, 11.6% - 12.5%).
The outcomes were similar when the authors included patients treated by nonhospitalist general internists.
When stratified by patient volume, the association between physician age and patient mortality was positive for low volumes (90 - 200 admissions per year), with each 10-year age increase associated with an adjusted odds ratio for 30-day mortality of 1.19 (95% CI, 1.14 - 1.23; P < .001) and 1.06 (95% CI, 1.03 to 1.09; P < .001), respectively.
"Further research is warranted to understand exactly why low- to medium-volume older physicians have worse outcomes, and how we can solve this problem," Dr Tsugawa told Medscape Medical News.
In other study endpoints, no correlation emerged between physician age and a 30-day readmission rate of about 15% across all age groups, for an adjusted odds ratio for each additional 10 years of 1.00 (95% CI, 0.99 - 1.01; P = .82). Variations in Medicare Part B spending by physician age were significant but small, with each decade increase correlating to a cost rise of 2.4% (95% CI, 2.0% - 2.8%; P <.001). Billings ranged from $1008 for physician billings in the under-40 age category to $1071 in the 60-and-older group.
The authors point to a recent resurgence of interest in how quality of care evolves during a physician's career and how continuing medical education should be integrated into busy clinical schedules in a tolerable manner.
They note that although quality-of-care initiatives have largely focused on system-level measures, "there is increasing policy emphasis on the role of individual physicians in influencing costs and quality of care," including the value-based payment models under the Medicare Access and CHIP Reauthorization Act (MACRA).
Dr Tsugawa said these data cannot indicate whether the effect of physician age would be so pronounced among younger acute care patients. "However, it is important to note that we found that the impact of physician age was similar among patients ages 65 to 75 — relatively young patients in our sample — and among Medicare beneficiaries age 64 or younger," he told Medscape Medical News. "That suggests that similar findings may be observed if we could study a younger patient population."
In 2016, Medscape Medical News reported on another outcome study by Dr Tsugawa's group showing that elderly patients treated by female physicians had lower mortality and readmission rates than those cared for by male physicians within the same hospital. The current age-based study, however, did not tease out the gender factor, Dr Tsugawa said.
The authors and Dr Aiken have disclosed no relevant financial relationships.
BMJ. Published online May 16, 2017. ArticleEditorial
For more news, join us on Facebook and Twitter

No comments: