Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up.
ABSTRACT The transition between the inpatient and outpatient setting is a high-risk period for patients. The presence and role of the primary care provider (PCP) is critical during this transition. This study evaluated characteristics and outcomes of discharged patients lacking timely PCP follow-up, defined as within 4 weeks of discharge.
This prospective cohort enrolled 65 patients admitted to University of Colorado Hospital, an urban 425-bed tertiary care center. We collected patient demographics, diagnosis, payer source and PCP information. Post-discharge phone calls determined PCP follow-up and readmission status. Thirty-day readmission rate and hospital length of stay (LOS) were compared in patients with and without timely PCP follow-up.
The rate of timely PCP follow-up was 49%. For a patient's same medical condition, the 30-day readmission rate was 12%. Patients lacking timely PCP follow-up were 10 times more likely to be readmitted (odds ratio [OR] = 9.9, P = 0.04): 21% in patients lacking timely PCP follow-up vs. 3% in patients with timely PCP follow-up, P = 0.03. Lack of insurance was associated with lower rates of timely PCP follow-up: 29% vs. 56% (P = 0.06), but did not independently increase readmission rate or LOS (OR = 1.0, P = 0.96). Index hospital LOS was longer in patients lacking timely PCP follow-up: 4.4 days vs. 6.3 days, P = 0.11.
Many patients discharged from this large urban academic hospital lacked timely outpatient PCP follow-up resulting in higher rates of readmission and a non-significant trend toward longer hospital LOS. Effective transitioning of care for vulnerable patients may require timely PCP follow-up.
- Journal of Emergencies Trauma and Shock 10/2014; 7(4):249-50.
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ABSTRACT: To assess the effect of an electronic health record–based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital.Journal of the American Geriatrics Society 05/2014; 62(5). · 4.22 Impact Factor
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ABSTRACT: Background: Failure to appropriately plan for a safe and effective transition to the next level of care leads to greater use of hospital and emergency services, often measured by rates of readmission. Despite a focus to develop programs to reduce readmissions, the 30-day all-cause readmission rate for Medicare patients in 2011 remained essentially unchanged. Purpose: The objective of this qualitative systematic review was to synthesize the evidence for interventions aimed at reducing readmissions through a transition of care program. Methods: We searched PubMed and Medline (OVID) with search terms including home care services, continuity of patient care, patient discharge, patient-centered care, health planning, and patient readmission. Selection criteria included quantitative studies, qualitative studies, and expert opinion articles in which a transition of care intervention, was implemented. The outcome of interest was readmission rates. Results: Thirty-three articles met inclusion criteria. The data were synthesized into two categories: primary studies in which the readmission rate was measured as an outcome, and studies that systematically reviewed interventions aimed at improving the discharge process. In all studies reviewed, a transitional care intervention resulted in a statistically significant reduction in readmission rate, or a rate trending lower, or the rate remained the same. Several studies evaluating an intervention occurring during and after hospitalization demonstrated significant results. Conclusion: There is value in reconfiguring discharge processes toward interventions that are more likely to reduce readmissions. The discharge process should incorporate a multidisciplinary, multicomponent transition of care intervention that involves hospital and home-care follow-up.Journal of Nursing Education and Practice. 06/2014; 4(6):37.