Abstract
BACKGROUND: Hospital family physicians are recognized for their excellence in managing complex issues. This study aimed to reveal the level of complexities of patients referred to hospital family physicians by community centers, and the degree of change in these complexities following care provided by a health care team that includes hospital family physicians. METHODS: A retrospective cohort analysis. Patients introduced by community centers between 2020 and 2023 were identified. The patients received team-based comprehensive care. Complexity was calculated before and after the care, using the patient-centered assessment method (PCAM), which evaluates 12 items across four domains. Each item is rated from 1 to 4, yielding a total score range of 12 to 48. Pre- and post-intervention scores were compared using paired-sample t-tests, with standardized mean difference calculated using Hedges' g. RESULTS: Of 41 referred patients, three died shortly after the initial consultation. Among the 38 remaining patients, 24 were admitted, and 14 were treated as outpatients. The mean PCAM score significantly decreased from 36.9 to 23.7 after interventions (P < .001, Hedges' g = 2.54). Scores improved significantly across all domains: health and well-being (2.96 vs 1.95; P < .001, g = 2.00), social environment (3.09 vs 1.96; P < .001, g = 2.38), health literacy and communication (2.78 vs 2.46; P < .001, g = 0.67), and service coordination (3.61 vs 1.57; P < .001, g = 4.68). CONCLUSION: Hospital family physicians in Japan often manage patients with exceptionally complex problems and improve patient outcomes across multiple domains.