Patients treated by older physicians have higher 30-day mortality than patients cared for by younger physicians, excluding physicians treating high volumes of patients, according to a study published in the BMJ.
Yusuke Tsugawa, MD, MPH, PhD, from the Harvard T.H. Chan School of Public Health in Cambridge, Mass., and colleagues conducted an observational study using a 20% random sample of Medicare fee-for-service beneficiaries aged 65 and older who were admitted to a hospital with a medical condition from January 1, 2011, to December 31, 2014. Participants were also treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. Analyses also included patients treated by general internists, including both hospitalists and non-hospitalists. To allow sufficient follow-up, the researchers excluded patients admitted in December 2014 from 30-day mortality analyses and patients discharged in December 2014 from readmission analyses.
Physician age was defined as the age on the date of admission of patients. Data on physician age were available for 93.5% of physicians. Age was defined as younger than 40, 40-49, 50-59, and older than 60 years. The primary outcome was the 30-day mortality rate in patients (death within 30 days of admission). Secondary outcomes were 30-day readmission rates (readmission within 30 days of discharge) and costs of care.
The median age among 18,854 hospitalist physicians in the sample in 2014 was 41.0. The overall 30-day mortality rate in the final sample of 736,537 hospital admissions was 11.1%. After adjustment for characteristics of patients and physicians and hospital fixed effects (effectively comparing physicians within the same hospital), the investigators found that patients’ adjusted 30-day mortality rates were 10.8% for physicians younger than 40 years old, 11.1% for physicians aged 40-49, 11.3% for physicians aged 50-59, and 12.1% for physicians older than aged 60.
Among physicians with a high volume of patients, no association was observed between physician age and patient mortality. Readmissions did not vary with physician age, while costs of care were slightly higher among older physicians.
“In a national sample of elderly Medicare beneficiaries admitted to hospital with medical conditions, we found that patients treated by older physicians had higher 30 day mortality than those cared for by younger physicians, despite similar patient characteristics,” the authors stated. “These associations were found among physicians with low and medium volumes of patients but not among those with high volumes…. Taken together, our findings suggest that differences in practice patterns or process measures of quality between physicians with varying years of experience reported in previous studies might have a meaningful impact on patient outcomes.”
- Tsugawa Y, Newhouse JP, Zaslavsky AM, et al. Physician age and outcomes in elderly patients in hospital in the US: observational study. BMJ. 16 May 2017. doi: 10.1136/bmj.j1797