Marcello Tonelli|Natasha Wiebe|Braden Manns|Scott Klarenbach|Matthew T. James|Pietro Ravani|Neesh Pannu|Jonathan Himmelfarb|Brenda R. Hemmelgarn
Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System
University of Calgary|University of Alberta|University of Calgary|University of Alberta|University of Calgary|University of Calgary|University of Alberta|University of Washington|University of Calgary
h3importanceh3 clinical experience suggests substantial differences patient complexity across medical specialties empirical data lacking h3objectiveh3 compare complexity patients seen different types physician universal health care system h3design setting participantsh3 populationbased retrospective cohort study 2 597 127 residents canadian province alberta aged 18 years older least 1 physician visit april 1 2014 march 31 2015 data analyzed september 2018 h3exposuresh3 type physician seeing patient family physician general internist 11 types medical subspecialist assessed nonmutually exclusive categories h3main outcomes measuresh3 nine markers patient complexity number comorbidities presence mental illness number types physicians involved patients care number physicians involved patients care number prescribed medications number emergency department visits rate death rate hospitalization rate placement longterm care facility h3resultsh3 among 2 597 127 participants median interquartile range age 46 3259 years 541 female 1 year followup 21 792 patients 08 died median range number days spent hospital 0 0365 81 patients least 1 hospitalization median interquartile range number prescribed medications 3 17 complexity markers considered individually patients seen nephrologists highest mean number comorbidities 42 95 ci 4243 vs lowest 11 95 ci 1011 highest mean number prescribed medications 142 95 ci 142143 vs lowest 49 95 ci 4949 highest rate death 66 95 ci 6369 vs lowest 01 95 ci lt0102 highest rate placement longterm care facility 20 95 ci 1822 vs lowest lt01 95 ci lt0101 patients seen infectious disease specialists highest complexity assessed 5 markers rate mental health condition 29 95 ci 2829 vs lowest 14 95 ci 1414 mean number physician types 55 95 ci 5556 vs lowest 21 95 ci 2121 mean number physicians 130 95 ci 129131 vs lowest 38 95 ci 3838 mean days hospital 150 95 ci 149150 vs lowest 04 95 ci 0404 mean emergency department visits 26 95 ci 2626 vs lowest 05 95 ci 0505 types physician ranked according patient complexity across 9 markers order least complex nephrologist infectious disease specialist neurologist respirologist hematologist rheumatologist gastroenterologist cardiologist general internist endocrinologist allergistimmunologist dermatologist family physician h3conclusion relevanceh3 substantial differences found 9 different markers patient complexity across different types physician including medical subspecialists general internists family physicians findings implications medical education health policy