Background:

Thirty–day readmissions in chronic obstructive pulmonary disease (COPD) patients are frequent and costly. National efforts to reduce 30–day readmissions often suggest a follow–up visit with a physician despite conflicting evidence about the value of such visits. Many studies on the effect of follow–up visits on readmissions have not been disease specific and have not considered whether a visit occurred. In this study, we examined the effect of a follow–up visit with the patient’s primary care physician (PCP) or a pulmonologist within the first 30 days after discharge on postdischarge failure (PDF).

Methods:

This was a retrospective cohort study of patients discharged from a tertiary academic center with a primary diagnosis of COPD between 2005 and 2011. Thirty–day readmissions, Emergency Department (ED) visits, and all–cause mortality were measured as indicators of PDF. We performed a Cox proportional hazard regression with time–dependent covariate to determine the risk of 30–day PDF in patients with or without a follow–up visit to their PCP and/or pulmonologist.

Results:

Six thousand and two hundred and seventy–six patients were discharged with a primary diagnosis of COPD, and 2,184 (34.8%) had a follow–up visit with their PCP and/or pulmonologist within 30 days of discharge. We performed univariate and multivariate regression to adjust our results for age, gender, Charlson comorbidity index, and index length of stay. In a multivariate, time–dependent analysis, patients who attended a follow–up visit had a significantly reduced risk of PDF. With follow–up the hazard ratio [HR] for 30–day readmissions was 0.39, 95% confidence interval [CI], 0.34–0.46, p < 0.0001. Thirty–day mortality was decreased, HR 0.359, CI 0.247–0.522, p < 0.0001. Thirty–day readmissions were slightly higher in patients who had follow–up with a pulmonologist compared with a PCP, but this difference was not significant. The HR for readmission was lowest, 0.058, CI 0.026–0.129, p < .0001, when the follow–up occurred during days 16–30 postdischarge compared with HR 0.366, CI 0.305–0.440, p < 0.0001 for follow–up on days 1–15.

Conclusions:

Our results indicate that a postdischarge follow–up visit with patient’s PCP or pulmonologist after acute hospitalization for COPD appears to lower the risk of 30–day readmission and mortality. Our results suggest a reduced risk, when the visit occurs between days 16 and 30 postdischarge, although this may be related to selection, measurement, or intervention bias.