Process and outcome of critical care provided by community and academic primary care physicians

Academic and community physicians traditionally have conducted their practices in separate settings. This study compared the process and outcome of critical care admissions of patients at one hospital by primary care physicians who were either in full-time academic positions or in community based practice. The comparison showed that community physicians treated an older patient population with a different diagnostic mix. Although the community physicians tended to serve older patients with Medicare coverage, the major difference between the two groups was that academic physicians requested 50% more consultations than community physicians (.86 and .56 consultations per admission, respectively). Analysis of outcome measures, such as survival time, readmission rate, and death rate, showed no differences. Survival analysis showed the risk of death to be significantly higher for patients of academic physicians (relative risk = 1.46, CI = 1.07,2.00). Other factors contributing significantly to the risk of death included severity of illness, patient age and race, and digestive diseases. The apparent differences in patient outcome between the two groups of physicians are more likely related to underlying differences in the patients than in the clinical approaches of their physicians.