Purpose: The Japanese healthcare system offers an openaccess model allowing patients to visit healthcare institutes or providers of their choice. We investigated the impact of using a primary care physician (PCP) on outcomes related to hospital admissions. Methods: All patients admitted to the internal medicine ward of the St. Luke's International Hospital, Tokyo between 2009 and 2015 were included. Patient data including demographics, medical history, date of admission and discharge, and presence of a PCP, were collected. Outcomes including hospital mortality, rate of ambulance transportation, readmission rate, and hospital length of stay (LoS) were analyzed. Results: Of 11,243 patients, 625 (5.6%) used a PCP. By bivariate analysis, those with a PCP were older and had higher Charlson index scores but had fewer episodes of requiring ambulance transport and after-hours admissions. Multivariable regression analysis demonstrated that the ambulance transport (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.30–0.74) and after-hours admission (OR, 0.76; 95% CI, 0.64–0.90) rates were significantly lower among patients using a PCP than among those without a PCP; however, neither hospital mortality (OR, 0.94; 95% CI, 0.68–1.31) nor LoS (β coefficient, −0.42; 95% CI, −2.25–2.17) were significantly different. Those using a PCP had a significantly higher readmission rate (OR, 2.18; 95% CI, 1.76–2.69); however, among the readmitted patients, outcomes were not different between the two groups. Conclusion: Patients using a PCP less frequently utilized hospitalization-related high-cost services such as ambulance use and after-hours hospital services but had a higher readmission rate. No differences in mortality or length of stay were found.
Yasuhiro Osugi, Gautam A Deshpande, Osamu Takahashi, Hiroko Arioka, Teruo Ino, Kanichi Asai, Daiki Kobayashi
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