Relationship Between Early Physician Follow-up and 30-Day Readmission Among Medicare Beneficiaries Hospitalized for Heart Failure
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- 5 May 2010
- journal article
- research article
- Published by American Medical Association (AMA)
- Vol. 303 (17), 1716-22
- https://doi.org/10.1001/jama.2010.533
Abstract
Context Readmission after hospitalization for heart failure is common. Early outpatient follow-up after hospitalization has been proposed as a means of reducing readmission rates. However, there are limited data describing patterns of follow-up after heart failure hospitalization and its association with readmission rates. Objective To examine associations between outpatient follow-up within 7 days after discharge from a heart failure hospitalization and readmission within 30 days. Design, Setting, and Patients Observational analysis of patients 65 years or older with heart failure and discharged to home from hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure and the Get With the Guidelines-Heart Failure quality improvement program from January 1, 2003, through December 31, 2006. Main Outcome Measure All-cause readmission within 30 days after discharge. Results The study population included 30 136 patients from 225 hospitals. Median length of stay was 4 days (interquartile range, 2-6) and 21.3% of patients were readmitted within 30 days. At the hospital level, the median percentage of patients who had early follow-up after discharge from the index hospitalization was 38.3% (interquartile range, 32.4%-44.5%). Compared with patients whose index admission was in a hospital in the lowest quartile of early follow-up (30-day readmission rate, 23.3%), the rates of 30-day readmission were 20.5% among patients in the second quartile (risk-adjusted hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.78-0.93), 20.5% among patients in the third quartile (risk-adjusted HR, 0.87; 95% CI, 0.78-0.96), and 20.9% among patients in the fourth quartile (risk-adjusted HR, 0.91; 95% CI, 0.83-1.00). Conclusions Among patients who are hospitalized for heart failure, substantial variation exists in hospital-level rates of early outpatient follow-up after discharge. Patients who are discharged from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission. Trial Registration clinicaltrials.gov Identifier: NCT00344513Keywords
This publication has 14 references indexed in Scilit:
- Linking inpatient clinical registry data to Medicare claims data using indirect identifiersAmerican Heart Journal, 2009
- Continuity of Outpatient and Inpatient Care by Primary Care Physicians for Hospitalized Older AdultsJama-Journal Of The American Medical Association, 2009
- Rehospitalizations among Patients in the Medicare Fee-for-Service ProgramThe New England Journal of Medicine, 2009
- Growth in the Care of Older Patients by Hospitalists in the United StatesThe New England Journal of Medicine, 2009
- Frequency of and Risk Factors for Preventable Medication-Related Hospital Admissions in the NetherlandsYearbook of Medicine, 2009
- Hospitalists And Care Transitions: The Divorce Of Inpatient And Outpatient CareHealth Affairs, 2008
- Coordinating Care — A Perilous Journey through the Health Care SystemThe New England Journal of Medicine, 2008
- Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional CareAnnals of Internal Medicine, 2004
- Organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF): rationale and designAmerican Heart Journal, 2004
- Falling Through the Cracks: Challenges and Opportunities for Improving Transitional Care for Persons with Continuous Complex Care NeedsJournal of the American Geriatrics Society, 2003