By Stephen Beech
Doctors vary widely in their likelihood of admitting a patient to hospital – even within the same facility, reveals new research.
Patients hospitalized by physicians with higher admission rates were likelier to be discharged within 24 hours, suggests the study.
But they were no less likely to die than patients hospitalized by physicians with lower admission rates, according to research published in JAMA Internal Medicine.
Dr. Dan Ly, Assistant Professor of Medicine at the David Geffen School of Medicine, UCLA, says the findings suggest that differences in physicians’ skill or risk aversion may come into play when they make admitting decisions.
He said: “Physicians, just like professionals in other domains, differ in their abilities and decisions, which has consequences for how much care you might receive, including, in this case, your likelihood of being hospitalized.
“Some physicians may order more tests and hospitalize more of their patients, but this doesn’t appear to translate to better health.”
Using electronic health records from Veterans Affairs for January 2011 through December 2019, the research team compared physicians practicing within the same emergency department.
The study captured data from 2,100 physicians in 105 emergency departments across the United States, comprising more than 2.1 million patient visits.
They focused on patients coming into the emergency department for chest pain, shortness of breath, or abdominal pain.
About 41% of the visits led to hospital admission, with 19% of those patients discharged in less than 24 hours.
Variation in admission rates varied greatly. For example, patients who saw high-admitting physicians were almost twice as likely to be admitted as patients who were treated by low-admitting physicians, even though their underlying health did not differ.
Overall, about 2.5% of patients died within 30 days.
The researchers found no relationship between a physician’s admission rate and the 30-day mortality rate of their patients. The lack of relationship was also true for seven-day, 14-day, 90-day, and one-year mortality.
The researchers say their findings suggest that differences across physicians in admission rates are driven less by a patient’s underlying health than variation in doctor decision-making.
The additional hospitalizations from high-admitting doctors led neither to short-term protection from severe outcomes nor to a reduction in patients’ risk for dying for up to a year afterward.
The research team found patients who were treated by physicians with a lower propensity to admit spent less total time after their emergency visit to the hospital, which suggests that low-propensity physicians were not simply deferring a necessary hospitalization into the future.
Dr. Ly says more research is needed to fully understand the differences in admission rates.
But he added: “Our study is able to better account for patient differences and make apples-to-apples comparisons between physicians to demonstrate true differences in ED physician practice patterns and show that these differences do not translate to better patient health outcomes.”
