Background: Post-discharge phone calls to hospitalized patients have been associated with reduced 30-day readmissions.[1,2] But their impact during the COVID-19 pandemic is unknown. Further, whether the 30-day readmission metric is an accurate surrogate for care utilization remains a concern.[3-5] Since 2012, national all-cause readmissions have decreased while emergency department (ED) visits and observation status have increased.[6-10] We aim to determine the impact of a post-discharge phone call on three 30-day utilization outcomes during the pandemic: readmission rates, ED visits, and observation status.

Methods: We conducted a retrospective analysis of 3,555 patients discharged home from three hospitals between December 2020 and July 2022. Patients discharged to home without additional skilled services qualified for a phone call. For each index hospital admission, we recorded whether there was one or more of each of the outcomes of interest within the 30-day period. We used this as the dependent variable in a series of logistic regressions to analyze the association of call receipt versus non-receipt and the outcomes. For each outcome, we looked at unadjusted odds ratios and performed three different adjusted models: one adjusted for patient demographics (age, sex, race); one adjusted for system variables (payer, length of stay, readmission index, AHRQ comorbidity count); and one adjusted for both patient and system covariates.

Results: Study participant demographics are shown in Table 1. When adjusted for patient and system covariates, the post-discharge phone call was associated with a significant reduction in 30-day observation status (OR 0.60, p < 0.05) (Table 2). A phone call was not associated with a significant reduction in 30-day ED visits (OR 0.98, p = 0.81) or 30-day readmission rates (OR 0.89, p = 0.41).

Conclusions: During the pandemic, the post-discharge phone call was not associated with a significant decrease in 30-day readmissions or ED visits. It was, however, associated with a significant reduction in 30-day observation status, which is where utilization has been rising since 2012. Though it did not impact readmissions, the post-discharge phone call shows the potential to affect areas of rising post-acute care utilization, a trend that prevailed during the pandemic.

IMAGE 1: Demographics and readmission status of patients based on the receipt of post-discharge phone call

IMAGE 2: Impact of post-discharge phone call on 30 day care utilization metrics