Outpatient Follow-up Visit and 30-Day Emergency Department Visit and Readmission in Patients Hospitalized for Chronic Obstructive Pulmonary Disease

Sharma, Gulshan; Kuo, Yong Fang; Freeman, Jean L.; Zhang, Dong D.; Goodwin, James S.

doi:10.1001/archinternmed.2010.345

Cited by 238 publications

(199 citation statements)

References 31 publications

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“…The effect of early visit on readmission and mortality, although more pronounced in the first week (days [8][9][10][11][12][13][14][15], persisted during the entire follow-up period. Table 4 displays the results of prespecified subgroup analyses.…”

Section: Propensity-score-matched Cohortmentioning

confidence: 99%

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Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

et al. 2016

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Preventing readmission has been the focus of numerous quality improvement efforts across many conditions. Early outpatient follow-up has been proposed as the best mechanism for reducing readmissions. The extent to which early outpatient follow-up averts readmission or improves outcomes in cirrhosis is not known. We evaluated the relationship between early outpatient follow-up and short-term readmission and mortality in patients with cirrhosis. We conducted a retrospective cohort study of patients with cirrhosis who were hospitalized with a liver-related diagnosis and discharged to home from 122 Veterans Administration hospitals between 2010 and 2013. We defined early follow-up as an outpatient visit with a clinician within 7 days after discharge. We propensity matched patients who received early visit with those who did not have any visit and examined the associations between early follow-up and all-cause readmission and mortality within 8-30 days after discharge. Of 25,217 patients hospitalized with cirrhosis, 8,123 (32.2%) had an early follow-up visit within 7 days of discharge. A total of 3,492 (13.8%) patients were readmitted and 1,185 (4.6%) died between 8 and 30 days after discharge. In the propensity-matched sample (N 5 16,238), patients with early outpatient follow-up visit had a slightly higher risk of readmission (15.3% vs. 13.8%; hazard ratio [HR] 51.10; 95% confidence interval [CI] 5 1.02-1.19), but significantly lower risk of mortality (3.2% vs. 5.2%; HR 5 0.60; 95% CI 5 0.51-0.70) than those without early visit. The findings persisted in several subgroup and sensitivity analyses. Conclusions: Early outpatient follow-up after discharge was associated with a small increase in readmissions but lower overall mortality in patients with cirrhosis. Transitional care may be effective in improving short-term outcomes in patients with cirrhosis, but readmission performance measures would miss this effect. (HEPATOLOGY 2016;64:569-581) C irrhosis is a common and costly condition.Most patients with cirrhosis require frequent hospitalizations. Approximately 20% of patients with cirrhosis who have been hospitalized get readmitted to the hospital within the first 30 days after discharge, with substantial implications for outcomes and cost of care. (1)(2)(3) Hospital readmission is a problem that is not unique to patients with cirrhosis. (4-6) Readmission rates and consequently readmission reduction programs have been a major focus of recent quality improvement initiatives across many chronic conditions. In 2012, the Centers for Medicare and Medicaid Services (CMS) began to invoke penalties for readmissions of patients who have been discharged after hospitalizations for congestive heart failure (CHF), pneumonia, and acute myocardial infarction. (7) Recently, the CMS also started to reimburse for early transitional care as a

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Section: Propensity-score-matched Cohortmentioning

confidence: 99%

“…Although this policy is set, the relationship between early clinician followup and reduced readmission rates is inconsistent across medical conditions. (10)(11)(12)(13) No data on this association exist in patients with cirrhosis.…”

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confidence: 99%

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

et al. 2016

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“…10,11 COPD, for instance, is the third leading cause of 30-day hospital readmissions. 12 Clinical practice guidelines for both asthma and COPD recommend that clinicians assess and teach respiratory inhaler technique at all points of care, including during hospitalizations. 13,14 However, studies that we and others have conducted have found that the vast majority of patients hospitalized with asthma or COPD misuse their inhalers.…”

Section: Introductionmentioning

confidence: 99%

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

et al. 2012

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BACKGROUND:Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population. OBJECTIVE: To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD. PARTICIPANTS: Hospitalized adults (age 18 years or older) with asthma or COPD. INTERVENTIONS: Participants were randomized to brief intervention [BI]: single-set of verbal and written step-by-step instructions, or, teach-to-goal [TTG]: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back). MAIN MEASURES: The primary outcome was metereddose inhaler (MDI) misuse post-intervention (<75% steps correct). Secondary outcomes included Diskus® misuse, self-reported inhaler technique confidence and prevalence of 30-day health-related events. KEY RESULTS: Of 80 eligible participants, fifty (63%) were enrolled (BI n=26, TTG n=24). While the majority of participants reported being confident with their inhaler technique (MDI 70%, Diskus® 94%), most misused their inhalers pre-intervention (MDI 62%, Diskus® 78%). Post-intervention MDI misuse was significantly lower after TTG vs. BI (12.5 vs. 46%, p= 0.01). The results for Diskus® were similar and approached significance (25 vs. 80%, p=0.05). Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI (1 vs. 8, p=0.02).CONCLUSIONS: TTG appears to be more effective compared with BI. Patients over-estimate their inhaler technique, emphasizing the need for hospital-based interventions to correct inhaler misuse. Although TTG was associated with fewer post-hospitalization healthrelated events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education.

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“…Step 2: Follow-up Appointment With PCP or Most Appropriate Continuity Provider Early follow-up with an appropriate outpatient provider has been associated with reduced hospital readmissions for patients with congestive heart failure, chronic obstructive pulmonary disease, and psychiatric illnesses, [26][27][28][29] but this finding has not been consistent across all patient populations. 5,30 It is not well understood if the follow-up appointment needs to be within a specific time frame, especially if the patient is already being "touched" once by the system through the posthospitalization call.…”

Section: After Hospital Dischargementioning

confidence: 99%

A primary care physician's ideal transitions of care—where's the evidence?

Tang

2013

Journal of Hospital Medicine

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Reducing hospital readmissions is a national healthcare priority. Most of the interventions to reduce hospital readmission have been concentrated in the inpatient setting. However, there is increasing attention placed on the role of primary care physicians (PCPs) in improving the transition from hospital to home. In this article, a primary care physician's perspective of how inpatient and outpatient providers can partner to create the ideal care transition is described. Seven steps that occur during the hospitalization are highlighted: communicate with the PCP on admission, involve the PCP early regarding discharge planning, notify the PCP on hospital discharge, complete the discharge summary at time of discharge, schedule follow‐up appointments by discharge, ensure prescriptions are available at the patient's pharmacy, and educate the patient about self‐management. Another 7 are described as the role of the PCP and clinic staff: call the patient within 72 hours of discharge, ensure follow‐up appointments with the PCP, coordinate care, repeat above until medically stable, create access for patients with new symptoms, track readmission rates, and track and review frequently admitted patients. Insights are offered on how the changing financial landscape can help support elements of this idealized transition‐of‐care program. Journal of Hospital Medicine 2013;8:472–477. © 2013 Society of Hospital Medicine

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Outpatient Follow-up Visit and 30-Day Emergency Department Visit and Readmission in Patients Hospitalized for Chronic Obstructive Pulmonary Disease

Cited by 238 publications

References 31 publications

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

A primary care physician's ideal transitions of care—where's the evidence?

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