Association between post-hospital clinic and telephone follow-up provider visits with 30-day readmission risk in an integrated health system.
Care transition
Post-discharge provider follow-up
Readmission
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
17 Aug 2021
17 Aug 2021
Historique:
received:
10
05
2021
accepted:
28
07
2021
entrez:
18
8
2021
pubmed:
19
8
2021
medline:
20
8
2021
Statut:
epublish
Résumé
Follow-up visits with clinic providers after hospital discharge may not be feasible for some patients due to functional limitations, transportation challenges, need for physical distancing, or fear of exposure especially during the current COVID-19 pandemic. The aim of the study was to determine the effects of post-hospital clinic (POSH) and telephone (TPOSH) follow-up provider visits versus no visit on 30-day readmission. We used a retrospective cohort design based on data from 1/1/2017 to 12/31/2019 on adult patients (n = 213,513) discharged home from 15 Kaiser Permanente Southern California hospitals. Completion of POSH or TPOSH provider visits within 7 days of discharge was the exposure and all-cause 30-day inpatient and observation stay readmission was the primary outcome. We used matching weights to balance the groups and Fine-Gray subdistribution hazard model to assess for readmission risk. Unweighted all-cause 30-day readmission rate was highest for patients who completed a TPOSH (17.3%) followed by no visit (14.2%), non-POSH (evaluation and management visits that were not focused on the hospitalization: 13.6%) and POSH (12.6%) visits. The matching weighted models showed that the effects of POSH and TPOSH visits varied across patient subgroups. For high risk (LACE 11+) medicine patients, both POSH (HR: 0.77, 95% CI: 0.71, 0.85, P < .001) and TPOSH (HR: 0.91, 95% CI: 0.83, 0.99, P = .03) were associated with 23 and 9% lower risk of 30-day readmission, respectively, compared to no visit. For medium to low risk medicine patients (LACE< 11) and all surgical patients regardless of LACE score or age, there were no significant associations for either visit type with risk of 30-day readmission. Post-hospital telephone follow-up provider visits had only modest effects on 30-day readmission in high-risk medicine patients compared to clinic visits. It remains to be determined if greater use and comfort with virtual visits by providers and patients as a result of the pandemic might improve the effectiveness of these encounters.
Sections du résumé
BACKGROUND
BACKGROUND
Follow-up visits with clinic providers after hospital discharge may not be feasible for some patients due to functional limitations, transportation challenges, need for physical distancing, or fear of exposure especially during the current COVID-19 pandemic.
METHODS
METHODS
The aim of the study was to determine the effects of post-hospital clinic (POSH) and telephone (TPOSH) follow-up provider visits versus no visit on 30-day readmission. We used a retrospective cohort design based on data from 1/1/2017 to 12/31/2019 on adult patients (n = 213,513) discharged home from 15 Kaiser Permanente Southern California hospitals. Completion of POSH or TPOSH provider visits within 7 days of discharge was the exposure and all-cause 30-day inpatient and observation stay readmission was the primary outcome. We used matching weights to balance the groups and Fine-Gray subdistribution hazard model to assess for readmission risk.
RESULTS
RESULTS
Unweighted all-cause 30-day readmission rate was highest for patients who completed a TPOSH (17.3%) followed by no visit (14.2%), non-POSH (evaluation and management visits that were not focused on the hospitalization: 13.6%) and POSH (12.6%) visits. The matching weighted models showed that the effects of POSH and TPOSH visits varied across patient subgroups. For high risk (LACE 11+) medicine patients, both POSH (HR: 0.77, 95% CI: 0.71, 0.85, P < .001) and TPOSH (HR: 0.91, 95% CI: 0.83, 0.99, P = .03) were associated with 23 and 9% lower risk of 30-day readmission, respectively, compared to no visit. For medium to low risk medicine patients (LACE< 11) and all surgical patients regardless of LACE score or age, there were no significant associations for either visit type with risk of 30-day readmission.
CONCLUSIONS
CONCLUSIONS
Post-hospital telephone follow-up provider visits had only modest effects on 30-day readmission in high-risk medicine patients compared to clinic visits. It remains to be determined if greater use and comfort with virtual visits by providers and patients as a result of the pandemic might improve the effectiveness of these encounters.
Identifiants
pubmed: 34404408
doi: 10.1186/s12913-021-06848-9
pii: 10.1186/s12913-021-06848-9
pmc: PMC8367769
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
826Informations de copyright
© 2021. The Author(s).
Références
JAMA. 2021 Feb 2;325(5):437-438
pubmed: 33528520
CMAJ. 2010 Apr 6;182(6):551-7
pubmed: 20194559
J Am Geriatr Soc. 2020 Jul;68(7):1392-1394
pubmed: 32383773
JAMA Intern Med. 2017 Jan 1;177(1):132-135
pubmed: 27893040
Stat Med. 2013 Aug 30;32(19):3388-414
pubmed: 23508673
JAMA Intern Med. 2020 Oct 1;180(10):1389-1391
pubmed: 32744593
Med Care. 2013 May;51(5):446-53
pubmed: 23579354
Stat Med. 2020 Jan 30;39(2):103-113
pubmed: 31660633
Ont Health Technol Assess Ser. 2017 May 25;17(8):1-37
pubmed: 28638496
JAMA Intern Med. 2014 Jul;174(7):1095-107
pubmed: 24820131
Mil Med. 1990 May;155(5):202-7
pubmed: 2114579
Ann Intern Med. 2011 Oct 18;155(8):520-8
pubmed: 22007045
Am Heart J. 2019 Jun;212:101-112
pubmed: 30978555
Int Psychogeriatr. 2011 Apr;23(3):344-55
pubmed: 20716393
JAMA Cardiol. 2019 Nov 1;4(11):1084-1091
pubmed: 31553402
JAMA Surg. 2014 Aug;149(8):821-8
pubmed: 25074237
Stat Methods Med Res. 2017 Aug;26(4):1654-1670
pubmed: 25934643
Stat Med. 2009 Nov 10;28(25):3083-107
pubmed: 19757444
Med Care. 2016 Apr;54(4):365-72
pubmed: 26978568
PLoS One. 2017 Jan 27;12(1):e0170061
pubmed: 28129332
N Engl J Med. 2020 Apr 30;382(18):1679-1681
pubmed: 32160451
Stat Med. 2017 May 30;36(12):1946-1963
pubmed: 28208229
JAMA Intern Med. 2020 Oct 1;180(10):1386-1389
pubmed: 32744601
JAMA Netw Open. 2020 Dec 1;3(12):e2031640
pubmed: 33372974
Epidemiology. 2017 May;28(3):387-395
pubmed: 28151746
JAMA. 2021 Jan 12;325(2):127-128
pubmed: 33369627
JAMA. 2010 May 5;303(17):1716-22
pubmed: 20442387