BACKGROUND:The transition between the inpatient and outpatient setting is a high‐risk period for patients. The presence and role of the primary care provider (PCP) is critical during this transition. This study evaluated characteristics and outcomes of discharged patients lacking timely PCP follow‐up, defined as within 4 weeks of discharge.METHODS:This prospective cohort enrolled 65 patients admitted to University of Colorado Hospital, an urban 425‐bed tertiary care center. We collected patient demographics, diagnosis, payer source and PCP information. Post‐discharge phone calls determined PCP follow‐up and readmission status. Thirty‐day readmission rate and hospital length of stay (LOS) were compared in patients with and without timely PCP follow‐up.RESULTS:The rate of timely PCP follow‐up was 49%. For a patient's same medical condition, the 30‐day readmission rate was 12%. Patients lacking timely PCP follow‐up were 10 times more likely to be readmitted (odds ratio [OR] = 9.9, P = 0.04): 21% in patients lacking timely PCP follow‐up vs. 3% in patients with timely PCP follow‐up, P = 0.03. Lack of insurance was associated with lower rates of timely PCP follow‐up: 29% vs. 56% (P = 0.06), but did not independently increase readmission rate or LOS (OR = 1.0, P = 0.96). Index hospital LOS was longer in patients lacking timely PCP follow‐up: 4.4 days vs. 6.3 days, P = 0.11.CONCLUSIONS:Many patients discharged from this large urban academic hospital lacked timely outpatient PCP follow‐up resulting in higher rates of readmission and a non‐significant trend toward longer hospital LOS. Effective transitioning of care for vulnerable patients may require timely PCP follow‐up. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

BackgroundSystematic attempts to identify best practices for reducing hospital readmissions have been limited without a comprehensive framework for categorizing prior interventions. Our research aim was to categorize prior interventions to reduce hospital readmissions using the ten domains of the Ideal Transition of Care (ITC) framework, to evaluate which domains have been targeted in prior interventions and then examine the effect intervening on these domains had on reducing readmissions.MethodsReview of literature and secondary analysis of outcomes based on categorization of English-language reports published between January 1975 and October 2013 into the ITC framework.Results66 articles were included. Prior interventions addressed an average of 3.5 of 10 domains; 41% demonstrated statistically significant reductions in readmissions. The most common domains addressed focused on monitoring patients after discharge, patient education, and care coordination. Domains targeting improved communication with outpatient providers, provision of advanced care planning, and ensuring medication safety were rarely included. Increasing the number of domains included in a given intervention significantly increased success in reducing readmissions, even when adjusting for quality, duration, and size (OR per domain, 1.5, 95% CI 1.1 - 2.0). The individual domains most associated with reducing readmissions were Monitoring and Managing Symptoms after Discharge (OR 8.5, 1.8 - 41.1), Enlisting Help of Social and Community Supports (OR 4.0, 1.3 - 12.6), and Educating Patients to Promote Self-Management (OR 3.3, 1.1 - 10.0).ConclusionsInterventions to reduce hospital readmissions are frequently unsuccessful; most target few domains within the ITC framework. The ITC may provide a useful framework to consider when developing readmission interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-423) contains supplementary material, which is available to authorized users.

Most academic hospitalists had not presented a poster at a national meeting, authored an academic publication, or presented grand rounds at their institution. Many academic hospitalists lacked mentorship and this was associated with a failure to produce scholarly activity. Mentorship may improve academic productivity among hospitalists.

Many high utilizers of the emergency department (ED) have public insurance, especially through Medicaid. We evaluated how participation in Bridges to Care (B2C)-an ED-initiated, multidisciplinary, community-based program-affected subsequent ED use, hospital admissions, and primary care use among publicly insured or Medicaid-eligible high ED utilizers. During the six months after the B2C intervention was completed, participants had significantly fewer ED visits (a reduction of 27.9 percent) and significantly more primary care visits (an increase of 114.0 percent), compared to patients in the control group. In a subanalysis of patients with mental health comorbidities, we found that recipients of B2C services had significantly fewer ED visits (a reduction of 29.7 percent) and hospitalizations (30.0 percent), and significantly more primary care visits (an increase of 123.2 percent), again compared to patients in the control group. The B2C program reduced acute care use and increased the number of primary care visits among high ED utilizers, including those with mental health comorbidities.