Primary care physicians' decisions about discharging patients from their practices

Area of Science:

• Medical Practice Management
• Physician Decision-Making
• Patient-Physician Relationship

Background:

• Limited data exists on factors influencing physician decisions to discharge patients.
• Understanding these factors is crucial for maintaining patient care standards.

Purpose of the Study:

• To investigate the attitudes and experiences of general internists and family medicine physicians regarding patient discharge.
• To identify demographic and practice-related factors associated with patient discharge decisions.

Main Methods:

• A cross-sectional mailed survey was distributed to 1000 general internists and family medicine physicians.
• Analysis included 526 completed surveys (54% response rate).
• Statistical methods included ANOVA and multiple logistic regression to analyze discharge likelihood and actual discharges.

Main Results:

• A majority of physicians were willing to discharge patients in hypothetical scenarios.
• 85% of physicians had discharged at least one patient, with 14% discharging 11-200 patients.
• Physicians in private practice, older physicians (≥48 years), and those in rural settings were more likely to discharge patients.

Conclusions:

• Physician willingness to discharge patients is common and influenced by practice type, age, and setting.
• These findings have implications for pay-for-performance programs and highlight the need for physician education on patient relationships and fiduciary duties.