Importance Despite the growing number of physicians who reduce clinical time owing to research, administrative work, and family responsibilities, the quality of care provided by these physicians remains unclear. Objective To examine the association between the number of days worked clinically per year by physicians and patient mortality. Design, Setting, and Participants This cross-sectional analysis was completed on a 20% random sample of Medicare fee-for-service beneficiaries 65 years and older who were admitted to the hospital with an emergency medical condition and treated by a hospitalist in 2011 through 2016. Because hospitalists typically work in shifts, hospitalists' patients are plausibly quasirandomized to hospitalists based on the hospitalists' work schedules (natural experiment). The associations between hospitalists' number of days worked clinically per year and 30-day patient mortality and readmission rates were examined, adjusting for patient and physician characteristics and hospital fixed effects (effectively comparing physicians within the same hospital). Data analysis was conducted from July 1, 2020, to July 2, 2021. Exposures Physicians' number of days worked clinically per year. Main Outcomes and Measures The primary outcome was 30-day patient mortality, and the secondary outcome was 30-day patient readmission. Results Among 392 797 hospitalizations of patients treated by 19 170 hospitalists (7482 female [39.0%], 11 688 male [61.0%]; mean [SD] age, 41.1 [8.8] years), patients treated by physicians with more days worked clinically exhibited lower mortality. Adjusted 30-day mortality rates were 10.5% (reference), 10.0% (adjusted risk difference [aRD], -0.5%; 95% CI, -0.8% to -0.2%; P = .002), 9.5% (aRD, -0.9%; 95% CI, -1.2% to -0.6%; P < .001), and 9.6% (aRD, -0.9%; 95% CI, -1.2% to -0.6%; P < .001) for physicians in the first (bottom), second, third, and fourth (top) quartile of days worked clinically, respectively. Readmission rates were not associated with the numbers of days a physician worked clinically (adjusted 30-day readmissions for physicians in the bottom quartile of days worked clinically per year vs those in the top quartile, 15.3% vs 15.2%; aRD, -0.1%; 95% CI, -0.5% to 0.3%; P = .61). Conclusions and Relevance In this cross-sectional study, hospitalized Medicare patients treated by physicians who worked more clinical days had lower 30-day mortality. Given that physicians with reduced clinical time must often balance clinical and nonclinical obligations, improved support by institutions may be necessary to maintain the clinical performance of these physicians.

中文翻译：

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医师兼职临床工作与患者结果之间的关联。

重要性 尽管由于研究、行政工作和家庭责任而减少临床时间的医生越来越多，但这些医生提供的护理质量仍不清楚。目的探讨医生每年临床工作天数与患者死亡率之间的关系。设计、设置和参与者 本横断面分析是在 2011 年至 2011 年至2016. 由于住院医师通常轮班工作，因此住院医师的患者可能会根据住院医师的工作时间表（自然实验）被准随机分配给住院医师。住院医师之间的关联 每年临床工作天数和 30 天患者死亡率和再入院率进行了检查，调整了患者和医生的特征以及医院的固定效应（有效地比较了同一家医院的医生）。数据分析于 2020 年 7 月 1 日至 2021 年 7 月 2 日进行。暴露医师每年在临床上工作的天数。主要结果和措施 主要结果是 30 天患者死亡率，次要结果是 30 天患者再入院。结果 19 170 名住院医师（7482 名女性 [39.0%]，11 688 名男性 [61.0%]；平均 [SD] 年龄，41.1 [8.8] 岁）治疗的 392 797 例住院患者中，接受医师治疗的患者临床工作天数较多表现出较低的死亡率。调整后的 30 天死亡率为 10.5%（参考），10。0%（调整后的风险差异 [aRD]，-0.5%；95% CI，-0.8% 至 -0.2%；P = .002），9.5%（aRD，-0.9%；95% CI，-1.2% 至 - 0.6%；P < .001）和 9.6%（aRD，-0.9%；95% CI，-1.2% 至 -0.6%；P < .001）对于第一（底部）、第二、第三和第四（上）四分位数的天数分别在临床上工作。再入院率与医生在临床上工作的天数无关（调整后的 30 天再入院率：每年临床工作天数最低的医生与最高四分位数的医生相比，15.3% 对 15.2%；aRD，-0.1% ；95% CI，-0.5% 至 0.3%；P = .61)。结论和相关性 在这项横断面研究中，由临床工作天数更长的医生治疗的住院医疗保险患者的 30 天死亡率较低。