Background: Research on post-discharge outpatient care often focuses on single types of encounters, such as primary care in-person appointments or primary care phone calls. However, patients interact with the healthcare system following discharge using a range of communication methods. This study seeks to examine the role of different types of post-discharge encounters on unplanned hospital readmissions in patients with an index admission for congestive heart failure.
Methods: This is a retrospective cohort study using a national Veterans Health Administration dataset of patients admitted with a principal diagnosis of congestive heart failure from 2012 to 2014. The outcome of interest is unplanned readmissions within 30 days of hospital discharge. The independent variables are different types of post-discharge outpatient encounters in the 30 days following hospital discharge: primary care appointments, phone calls with primary care, phone calls with a 24-hour triage nurse, phone calls with a telemonitoring nurse, and cardiology appointments. We used multivariable logistic regressions to determine the impact of post-discharge outpatient encounters on unplanned 30-day readmissions while controlling for age, race/ethnicity, Charlson/Deyo comorbidity index, length of hospital admission, and number of admissions in the 12 months prior to the index admission.
Results: There were 37,675 index admissions that met the inclusion criteria. The unadjusted 30-day readmission rate was 17.1%. Veterans with a readmission were older (71.8 (11.5) vs. 72.4 (11.2), p<0.001), had more comorbidities (Charlson/Deyo Comorbidity Index, 2.2 (2.1) vs. 2.7 (2.2), p<0.001), and had a shorter hospital length of stay for the index admission (4.9(5.4) vs. 4.4(3.4), p<0.001). The odds of an unplanned 30-day readmission were no different between Veterans with and without a primary care appointment following discharge (OR 1.0, CI 0.95-1.06; Adjusted OR 0.98). The odds of an unplanned 30-day readmission were higher for Veterans who had a phone call with primary care (OR 1.29, CI 1.20-1.37; Adjusted OR 1.22), a phone call with a 24-hour triage nurse (OR 1.78, CI 1.67-1.90; Adjusted OR 1.77), a phone call with a telemonitoring nurse (OR 1.10, CI 1.02-1.18; Adjusted OR 1.05), and a cardiology appointment (OR 1.21, CI 1.14-1.29; Adjusted OR 1.27).
Conclusions: Veterans use a range of post-discharge outpatient resources following hospital discharge. Patients who are readmitted in the 30 days following hospital discharge have more post-discharge outpatient encounters. Learning Healthcare Systems may be able to use post-discharge outpatient encounters to identify patients at risk for hospital readmission.