Ambulatory Follow-up and Outcomes Among Medicare Beneficiaries After Emergency Department Discharge

Lin, Michelle; Burke, Ryan; Orav, E. John; Friend, Tynan H.; Burke, Laura

doi:10.1001/jamanetworkopen.2020.19878

Cited by 35 publications

(48 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this large, commercially insured population, overall use of outpatient visits after hospital discharge did not change significantly, even as telemedicine use increased. The percentage of patients completing a postdischarge visit stayed around 70%-consistent with findings prior to the pandemic 3 -even as general ambulatory visits dropped significantly.…”

Section: Discussionsupporting

confidence: 77%

Trends in Outpatient Care and Use of Telemedicine After Hospital Discharge in a Large Commercially Insured Population

Bressman

Russo²,

Werner

2021

JAMA Health Forum

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 77%

Trends in Outpatient Care and Use of Telemedicine After Hospital Discharge in a Large Commercially Insured Population

Bressman

Russo²,

Werner

2021

JAMA Health Forum

View full text Add to dashboard Cite

show abstract

“…Many confounders make this question challenging to answer using observational study designs. 25,28,31 For example, patients may be more likely to seek outpatient care if their symptoms worsen rather than improve, leading to greater adverse outcomes among patients who obtain outpatient care. Conversely, patients with severe symptoms may be less able to attend an outpatient clinic visit, resulting in more adverse outcomes among patients who do not obtain outpatient care.…”

Section: Discussionmentioning

confidence: 99%

“…11,15,16,25,26 The responsibility for arranging follow-up care is often placed on patients and their families, many of whom will encounter barriers in accessing timely primary or specialty care. 27-29…”

mentioning

confidence: 99%

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Kilaru

Illenberger

Meisel

et al. 2022

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background: Patients who are discharged from the emergency department (ED) after an encounter for acute heart failure are at high risk for return hospitalization. These patients may benefit from timely outpatient follow-up care to reassess volume status, adjust medications, and reinforce self-care strategies. This study examines the incidence of outpatient follow-up care after ED encounters for acute heart failure and describes patient characteristics associated with obtaining timely follow-up care. Methods: We conducted a retrospective cohort study using an administrative claims database for a large US commercial insurer, from January 1, 2012 to June 30, 2019. Participants included adult patients discharged from the ED with principal diagnosis of acute heart failure. The primary outcome was obtaining an in-person outpatient clinic visit for heart failure within 30 days. We also examined the competing risk of all-cause hospitalization within 30 days and without an intervening outpatient clinic visit. We estimated competing risk regression models to identify patient characteristics associated with obtaining outpatient follow-up and report cause-specific hazard ratios. Results: The cohort included 52 732 patients, with mean age of 73.9 years (95% CI, 73.8–74.0) and 27 395 (52.0% [95% CI, 51.5–52.4]) female patients. Within 30 days of the ED encounter, 12 279 (23.2%) patients attended an outpatient clinic visit for heart failure, with 8382 (15.9%) patients hospitalized before they could obtain an outpatient clinic visit. In the adjusted analysis, patients that were younger, women, reporting non-Hispanic Black race, and had fewer previous clinic visits were less likely to obtain outpatient follow-up care. Conclusions: Few patients obtain timely outpatient follow-up after ED visits for heart failure, although nearly 20% require hospitalization within 30 days. Improved transitions following discharge from the ED may represent an opportunity to improve outcomes for patients with acute heart failure.

show abstract

“…The third possibility is that the underlying assumption that successful care transitions programs should always result in decreased ED revisits for all older adults, without regard to population heterogeneity, is false. A differentiated patient‐centric approach would allow us to embrace evidence that care transition programs may result in increased revisits for some patients once care is optimized (e.g., those with greater medical complexity), without branding that as a failure or null finding 14,22,51 11,12,15,52 .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Jacobsohn

Jones

Green

et al. 2021

Academic Emergency Medicine

View full text Add to dashboard Cite

Background Improving care transitions following emergency department (ED) visits may reduce post‐ED adverse events among older adults (e.g., ED revisits, decreased function). The Care Transitions Intervention (CTI) improves hospital‐to‐home transitions; however, its effectiveness at improving post‐ED outcomes is unknown. We tested the effectiveness of the CTI with community‐dwelling older adult ED patients, hypothesizing that it would reduce revisits and increase performance of self‐management behaviors during the 30 days following discharge. Methods We conducted a randomized controlled trial among patients age ≥ 60 discharged home from one of three EDs in two states. Intervention participants received a minimally modified CTI, with a home visit 24 to 72 h postdischarge and one to three phone calls over 28 days. We collected demographic, health status, and psychosocial data at the initial ED visit. Medication adherence and knowledge of red flag symptoms were assessed via phone survey. Care use and comorbidities were abstracted from medical records. We performed multivariate regressions for intention‐to‐treat and per‐protocol (PP) analyses. Results Participant characteristics (N = 1,756) were similar across groups: mean age 72.4 ± 8.6 years and 53% female. Of those randomized to the intervention, 84% completed the home visit. Overall, 12.4% of participants returned to the ED within 30 days. The CTI did not significantly affect odds of 30‐day ED revisits (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.72 to 1.30) or medication adherence (AOR = 0.89, 95% CI = 0.60 to 1.32). Participants receiving the CTI (PP) had increased odds of in‐person follow‐up with outpatient clinicians during the week following discharge (AOR = 1.24, 95% CI = 1.01 to 1.51) and recalling at least one red flag from ED discharge instructions (AOR = 1.34 95% CI = 1.05 to 1.71). Conclusions The CTI did not reduce 30‐day ED revisits but did significantly increase key care transition behaviors (outpatient follow‐up, red flag knowledge). Additional research is needed to explore if patients with different conditions benefit more from the CTI and whether decreasing ED revisits is the most appropriate outcome for all older adults.

show abstract

Ambulatory Follow-up and Outcomes Among Medicare Beneficiaries After Emergency Department Discharge

Cited by 35 publications

References 38 publications

Trends in Outpatient Care and Use of Telemedicine After Hospital Discharge in a Large Commercially Insured Population

Trends in Outpatient Care and Use of Telemedicine After Hospital Discharge in a Large Commercially Insured Population

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Contact Info

Product

Resources

About