Does Scheduling a Postdischarge Visit with a Primary Care Physician Increase Rates of Follow-up and Decrease Readmissions?

Marcondes, Felippe O.; Punjabi, Prakash P; Doctoroff, Lauren; Tess, Anjala; O‘Neill, Sarah; Layton, Timothy J.; Quist, Kramer; Mehrotra, Ateev

doi:10.12788/jhm.3309

Cited by 9 publications

(8 citation statements)

References 23 publications

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“…To the best of our knowledge, associations between medical consultations and readmission risk have been inconsistently reported in the past. Only one randomized interventional study has shown the paradoxical increase in readmission risk following consultation [12], whereas other retrospective studies observed a lower risk [13][14][15][16]. The GP and specialist consultations in our study showed two opposite associations, neutralizing each other when analyzed together; thus, overall, consulting a physician was not associated with 30-day readmission risk.…”

Section: Discussioncontrasting

confidence: 65%

Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort study

John¹,

Payrard²,

Donzé³

2022

European Journal of Internal Medicine

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Background: The period following hospital discharge is one of significant vulnerability. Little is known about the relationship between post-discharge healthcare use and the risk of readmission. Objectives: To explore associations between medical consultations and other healthcare use parameters and the risk of 30-day unplanned hospital readmission. Methods: Between July 2017 and March 2018, we monitored all adult internal medicine patients for 30 days after their discharge from four mid-sized hospitals. Using follow-up telephone calls, we assessed their post-discharge healthcare use: consultations with general practitioners (GPs) and specialist physicians, emergency room (ER) visits, and home visits by nurses. The binary outcome was defined as any unplanned hospital readmission within 30 days of discharge, and this was analyzed using logistic regression. Results: Of 934 patients discharged, 111 (12%) experienced at least one unplanned hospital readmission within 30 days. Attending at least one GP consultation decreased the odds of readmission by half (adjusted OR: 0.5; 95% CI: 0.3-0.7), whereas attending at least one specialist consultation doubled those odds (aOR: 2.0; 95%CI: 1.2-3.3). GP consultations also reduced the odds of the combined risk of an ER visit or unplanned hospital readmission (aOR: 0.5; 95%CI: 0.3-0.7). ER visits were also associated with a higher readmission risk after adjusting for confounding factors (aOR: 10.0; 95%CI: 6.0-16.8). Conclusion: GP consultations were associated with fewer ER visits and unplanned hospital readmissions.

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Section: Discussioncontrasting

confidence: 65%

Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort study

John¹,

Payrard²,

Donzé³

2022

European Journal of Internal Medicine

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“…For example, at one tertiary care center, a scheduling assistance program increased rate of PCP follow-up and decreased readmissions after inpatient hospital admissions. 27 At integrated health systems, generating an automated PCP appointment after an ED visit for SC to ensure comprehensive discharge planning could improve timely access to follow-up, with the goal of reducing unnecessary ED visits. The problem becomes more complicated for uninsured patients.…”

Section: Discussionmentioning

confidence: 99%

Identifying vulnerable populations with symptomatic cholelithiasis at risk for increased health care utilization

Shenoy

Kirkland

Jackson

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Gallstones are a common problem in the United States with many patients suffering from symptomatic cholelithiasis (SC). Patients with SC may first present to the emergency department ED) and are often discharged for elective follow-up; however, it is unknown what system and patient factors are associated with increased risk for ED revisits. This study aimed to assess longitudinal ED utilization and cholecystectomy for patients with SC and identify patient, geographic, and hospital characteristics associated with ED revisits, specifically race/ethnicity and insurance status. METHODS:Patients discharged from the ED with SC between July 1, 2016, and December 31, 2017, were identified from California administrative databases and followed for 1 year. Emergency department revisits and cholecystectomy after discharge were examined using logistic regression, clustering standard errors by hospital. Models adjusted for patient, geographic, and hospital variables using census and hospital administrative data. RESULTS:Cohort included 34,427 patients who presented to the ED with SC and were discharged. There were 18.8% of the patients that had one or more biliary-related ED revisits within 1 year. In fully adjusted models, non-Hispanic Black patients had higher odds for any ED revisit (adjusted odds ratio 1.23; 95% confidence interval, 1.09-1.39) and for two more ED revisits (adjusted odds ratio 1.48; 95% confidence interval, 1.20-1.82). Insurance type was also associated with ED revisits. CONCLUSION:Non-Hispanic Black patients experienced higher utilization of health care resources for SC after adjusting for other patient, geographic and hospital variables. Strategies to mitigate these disparities may include the development of standardized protocols regarding the follow-up and education for SC. Implementation of such strategies can ensure equitable treatment for all patients.

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“…18,19 Additionally, scheduling follow-up appointments before discharge leads to increased primary care follow-up and potentially decreased readmission rate. 20…”

Section: Introductionmentioning

confidence: 99%

“…18,19 Additionally, scheduling follow-up appointments before discharge leads to increased primary care follow-up and potentially decreased readmission rate. 20 Previous studies have demonstrated improvement in the completion and quality of discharge summaries following educational interventions targeted toward medical trainees, 14,15,[21][22][23] and some have utilized quality improvement (QI) methodology. 6,24,25 However, few studies have demonstrated a sustainable change in pediatric settings in the era of electronic health record (EHR) use.…”

Section: Introductionmentioning

confidence: 99%

A Quality Improvement Approach to Improving Discharge Documentation

Banker

Lakhaney

Hooe

et al. 2022

Pediatric Quality &Amp; Safety

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Does Scheduling a Postdischarge Visit with a Primary Care Physician Increase Rates of Follow-up and Decrease Readmissions?

Cited by 9 publications

References 23 publications

Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort study

Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort study

Identifying vulnerable populations with symptomatic cholelithiasis at risk for increased health care utilization

A Quality Improvement Approach to Improving Discharge Documentation

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