The association between hospital care transition planning and timely primary care follow‐up

Abstract

Purpose To determine whether Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Care Transitions (CTM‐3) Scores were associated with timely (14‐day) primary care provider (PCP) follow‐up visits, and to look for disparities across various types of urban and rural hospitals. Methods Data were obtained for 3,299 hospitals: 2,000 urban, 544 micropolitan prospective payment system (PPS), 109 micropolitan critical access hospital (CAH), 252 noncore rural PPS, and 394 noncore rural CAH. HCAPPS data were drawn from CMS Hospital Compare (2015). The dependent variable, 14‐day PCP follow‐up rate for each hospital, was drawn from the 2015 Dartmouth Atlas. Findings In analysis adjusting only for hospital characteristics, higher CTM‐3 scores were positively associated with PCP follow‐up; however, the relationship was no longer significant after controlling for area‐level (contextual) measures, such as percent minority population, percent unemployed, and percent uninsured. In the fully adjusted model, rates of PCP follow‐up were significantly higher for micropolitan PPS, noncore PPS, and noncore CAH hospitals than for urban hospitals. Conclusions In fully adjusted analysis, the lack of significance between CTM‐3 scores and PCP follow‐up suggests that community characteristics facilitate or impede timely PCP follow‐up to an extent that may overshadow in‐hospital efforts. Disparities between CAHs and rural PPS hospitals may be due to differing enrollments in quality incentive plans; future research is needed to address this issue. Compounding this issue, the strong negative relationship between percent Medicaid reimbursement (payor mix) and PCP follow‐up suggests possible disparities for safety net hospitals.

Transição e continuidade do cuidado após alta hospitalar de sobreviventes da COVID-19

“…Utilizaram medicações vasoativas 83 (27,7%) pacientes, e método dialítico, 15 (5%). A mediana de tempo de permanência no hospital foi de 13 dias (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Apenas 10 (3,3%) pacientes reinternaram em até 30 dias após a alta.…”

“…Neste estudo, observou-se que aqueles com consulta no hospital pós-alta tiveram melhor percepção da qualidade da transição do cuidado. Outra investigação constatou que escores mais altos de transição de cuidado eram associados a taxas mais altas de consulta de acompanhamento na atenção primária (26) . Diante disso, apesar de inúmeras dificuldades para realizar o acompanhamento pós-alta, reconhece-se que o seguimento por meio de contato telefônico, visita domiciliar e/ou consulta na atenção primária pode evitar a readmissão hospitalar e o atendimento em serviços de emergência (27,28) .…”

Transition and continuity of care after hospital discharge for COVID-19 survivors

“…In this study, it was observed that those with a hospital appointment after discharge had a better perception of care transition quality. Another investigation found that higher care transition scores were associated with higher rates of follow-up appointment in primary care (26) . Therefore, despite numerous difficulties in carrying out post-discharge follow-up, it is recognized that follow-up through telephone contact, home visits and/or appointment in primary care can avoid hospital readmission and emergency care (27,28) .…”