Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults.

Field TS1, Ogarek J, Garber L, Reed G, Gurwitz JH.

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Abstract

BACKGROUND:

Rehospitalizations within 30 days of discharge are responsible for a large portion of healthcare spending. One approach to preventing rehospitalizations is early follow-up, usually defined as an office visit with a primary care physician within 7 days of discharge--an approach that is being incentivized by health plans. However, evidence regarding its effectiveness is limited.

OBJECTIVE:

We aimed to determine whether an office visit with a primary care physician within 7 days after discharge is associated with 30-day rehospitalization.

DESIGN:

This was an observational study set within a randomized trial.

PARTICIPANTS:

The study included patients age 65 and older receiving care from a multi-specialty group practice and discharged from hospital to home between 26 August 2010 and 25 August 2011. To control for confounding, we identified characteristics of patients and hospital stays that are predictive of rehospitalization, and also developed high-dimensional propensity scores. Analyses used Cox proportional hazards models and took into account varying amounts of opportunity time for office visits.

MAIN MEASURES:

We looked at 30-day rehospitalizations at any hospital.

KEY RESULTS:

Of 3,661 patients discharged to home during the study year, 707 (19.3%) were rehospitalized within 30 days. Patients receiving an office visit within 7 days numbered 1,808 (49.4%), and of these, 1,000 (27.3%) were with a primary care physician. In models predicting rehospitalization, stratified on deciles of propensity score and controlling for additional confounders, the hazard ratios associated with office visits with a primary care physician within 7 days were 0.98 (95% CI 0.80, 1.21); for visits with any physician, the hazard ratio was HR 1.04, (95% CI 0.87, 1.25).

CONCLUSIONS:

We found no protective effect for office visits within 7 days. Such visits may need to be specifically focused on a range of issues related to the specific reasons why patients are rehospitalized. It is likely that outpatient visits will need to be set within comprehensive transition programs.