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Journal of General Internal Medicine

Erschienen in:

01.05.2015 | Original Research

Association of Early Post-Discharge Follow-Up by a Primary Care Physician and 30-Day Rehospitalization Among Older Adults

verfasst von: Terry S. Field, DSc, Jessica Ogarek, MS, Lawrence Garber, MD, George Reed, PhD, Jerry H. Gurwitz, MD

Erschienen in: Journal of General Internal Medicine | Ausgabe 5/2015

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ABSTRACT

BACKGROUND

Rehospitalizations within 30 days of discharge are responsible for a large portion of healthcare spending. One approach to preventing rehospitalizations is early follow-up, usually defined as an office visit with a primary care physician within 7 days of discharge—an approach that is being incentivized by health plans. However, evidence regarding its effectiveness is limited.

OBJECTIVE

We aimed to determine whether an office visit with a primary care physician within 7 days after discharge is associated with 30-day rehospitalization.

DESIGN

This was an observational study set within a randomized trial.

PARTICIPANTS

The study included patients age 65 and older receiving care from a multi-specialty group practice and discharged from hospital to home between 26 August 2010 and 25 August 2011. To control for confounding, we identified characteristics of patients and hospital stays that are predictive of rehospitalization, and also developed high-dimensional propensity scores. Analyses used Cox proportional hazards models and took into account varying amounts of opportunity time for office visits.

MAIN MEASURES

We looked at 30-day rehospitalizations at any hospital.

KEY RESULTS

Of 3,661 patients discharged to home during the study year, 707 (19.3 %) were rehospitalized within 30 days. Patients receiving an office visit within 7 days numbered 1,808 (49.4 %), and of these, 1,000 (27.3 %) were with a primary care physician. In models predicting rehospitalization, stratified on deciles of propensity score and controlling for additional confounders, the hazard ratios associated with office visits with a primary care physician within 7 days were 0.98 (95 % CI 0.80, 1.21); for visits with any physician, the hazard ratio was HR 1.04, (95 % CI 0.87, 1.25).

CONCLUSIONS

We found no protective effect for office visits within 7 days. Such visits may need to be specifically focused on a range of issues related to the specific reasons why patients are rehospitalized. It is likely that outpatient visits will need to be set within comprehensive transition programs.

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Titel: Association of Early Post-Discharge Follow-Up by a Primary Care Physician and 30-Day Rehospitalization Among Older Adults
verfasst von: Terry S. Field, DSc
Jessica Ogarek, MS
Lawrence Garber, MD
George Reed, PhD
Jerry H. Gurwitz, MD
Publikationsdatum: 01.05.2015
Verlag: Springer US
Erschienen in: Journal of General Internal Medicine / Ausgabe 5/2015
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-014-3106-4

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Association of Early Post-Discharge Follow-Up by a Primary Care Physician and 30-Day Rehospitalization Among Older Adults