HOSPITAL FOLLOW-UP: DOES PROVIDER, CONTINUITY, TIMING MATTER IN REDUCING READMISSIONS?

Background: Hospital readmissions are frequent and can represent low-quality, high-cost care. Timely post-hospital follow-up has been described as an important element of high-quality transitions of care and readmissions prevention (1-3), yet exactly what type of follow-up is most successful is unclear. We sought to understand the relationship between timing, hospital follow-up visit provider specialty and match with patient’s established primary care provider (PCP) on readmission rates.

Methods: We analyzed data from 4,672 hospital encounters of patients who received primary care at our institution and were hospitalized on the general medicine service of one of our two hospitals between April and September 2022. During this time period, 23.4% of hospital encounters were followed by completed PCP visits within 7 days of discharge and 25.7% by completed specialty visits within 7 days. 14-day and 30-day readmission rates were 8% and 14%, respectively. To estimate the association between factors related to the appointment completion (y vs. n) and the readmission (y vs n), we performed logistic regression analyses using SAS (2016, Cary, NC, USA). Results are summarized using odds ratios (OR), their 95% confidence intervals (CIs) and p-values.

Results: Completing a hospital follow-up visit with a PCP within 7 days of discharge was associated with decreased 14-day (0.69 (0.53 – 0.91), p=0.009) and 30-day (0.73 (0.59 – 0.90), p=0.003) readmission. Completing follow-up visit with a PCP within 14 days of discharge was associated with decreased 30-day readmission (0.61 (0.51 – 0.74) p< 0.001), with most of this effect driven by 0-7 day visits. Completing a follow-up visit with the patient’s own PCP rather than any PCP was associated with lower risk of 14-day (0.49 (0.30 – 0.82), p=0.006) and 30-day (0.58 (0.93 – 0.89), p=0.007) readmission. Of patients scheduled with specialty follow-up, completing a follow-up visit within 7 days of discharge was associated with lower 14-day (0.66 (0.49 – 0.90), p=0.009) but not 30-day readmission (0.85 (0.66 – 1.10), p=0.22).

Conclusions: Hospital follow-up appointment provider and timing after discharge were associated with differences in readmission rates. Prioritizing the patient’s own PCP and timing within 7 days of discharge in the scheduling of hospital follow-up appointments may maximize the benefit of post-hospital follow-up visits in decreasing hospital readmissions.