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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.

Background Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up. Objectives We sought to evaluate the effectiveness of CGA in hospital for older adults admitted as an emergency. Search methods We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), the Database of Abstracts of Reviews of Effects (DARE), MEDLINE, EMBASE, CINAHL and AARP Ageline, and handsearched high-yield journals. Selection criteria We searched for randomised controlled trials comparing CGA (whether by mobile teams or in designated wards) to usual care. Data collection and analysis Two review authors initially assessed eligibility and trial quality and extracted published data. Main results Twenty-two trials evaluating 10,315 participants in six countries were identified. Patients in receipt of CGA were more likely to be alive and in their own homes at up to six months (OR 1.25, 95% CI 1.11 to 1.42, P = 0.0002) and at the end of scheduled follow up (median 12 months) (OR 1.16, 95% CI 1.05 to 1.28, P = 0.003) when compared to general medical care. In addition, patients were less likely to be institutionalised (OR 0.79, 95% CI 0.69 to 0.88, P < 0.0001). They were less likely to suffer death or deterioration (OR 0.76, 95% CI 0.64 to 0.90, P = 0.001), and were more likely to experience improved cognition in the CGA group (OR 1.11, 95% CI 0.20 to 2.01, P = 0.02). Subgroup interaction in the primary outcomes suggests that the effects of CGA are primarily the result of CGA wards. Authors’ conclusions Comprehensive geriatric assessment increases a patient’s likelihood of being alive and in their own home at up to 12 months.

Our analysis using EHR data maintains that pressure-injury prevention for all inpatients is cost-effective. Hospitals should invest in nursing compliance with international prevention guidelines.

Hospitalists and PCPs encounter similar challenges in care coordination, yet have important experiential differences related to sending and receiving roles for hospital discharges. Efforts to improve coordination of care between hospitalists and PCPs should aim to understand perspectives of clinicians in each setting.