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In an ideal world, a patient’s continuity of care should be seamless when he is admitted to a hospital and when he is discharged. Managed care is supposed to step in and make that transition easier, but that isn’t the case, according to a recent study titled “Continuity of Outpatient and Inpatient Care by Primary Care Physicians for Hospitalized Older Adults.”

“Health plans should make efforts to ensure communication between all the parties involved,” says Gulshan Sharma, MD, MPH, one of the authors. “This communication should occur both from PCP to hospitalist at admittance and from hospitalist to PCP during discharge, either by phone or electronic health record.” Sharma emphasizes that an obstacle to inpatient-outpatient management is lack of communication during the admission process and misunderstanding about who is responsible after discharge.

Sharma and his colleagues found that a patient in a hospital may be visited by a doctor he’s seen as an outpatient, but in 2006, that visit was less likely to happen than in 1996. In 1996, more than 50 percent of hospitalized patients were seen by at least one physician that they had visited in an outpatient setting in the previous year. In addition, 44 percent of patients with a regular physician were seen by that physician during their hospital stay.

By 2006, however, only 39.8 percent of patients received care from any physician that they had seen at least once in an outpatient setting before the hospitalization. Also, about 32 percent of patients with a regular physician were visited by that physician when hospitalized.

These decreases occurred in all areas of the country, in all types of hospitals, and for all diagnoses.