Adverse events are common following hospital discharge. To assist patients in their transition from hospital to home, healthcare systems have established several methods for patients to interact with the healthcare system following discharge. However, little is known about how these methods are utilized. The Veterans Health Administration (VHA) is an integrated healthcare system that provides patients with ready access to a wide range of outpatient services. We sought to determine if there were differences in the frequency of outpatient encounters for patients with congestive heart failure who are readmitted to the hospital within 30‐days of discharge as compared to patients who are not readmitted.
We performed a retrospective, cross‐sectional study of outpatient encounters in the 30‐days following hospital discharge from a large, regional VHA Medical Center for the primary diagnosis of congestive heart failure. All patients discharged from October 1, 2012 to September 30, 2013 were included. We counted all patient initiated encounters for the VHA facility within 30‐days of hospital discharge, including: emergency room visits, primary care scheduled appointments, primary care walk‐in visits, cardiology clinic appointments, phone calls to primary care clinic, phone calls to 24 hour nursing help line, and phone calls to nurses performing telemonitoring. A student’s t‐test was used to evaluate differences in outpatient encounters between patients who were readmitted within 30‐days of discharge and patients who were not readmitted.
There were 623 patients discharged with a primary diagnosis of congestive heart failure. 137 patients were readmitted within 30‐days of discharge. Patients who were readmitted had a higher rate of outpatient encounters (6.93 versus 3.47 encounters per patient, p<0.001). Patients who were readmitted had higher rates of contact with their primary care team through scheduled appointments (0.99 versus 0.74 encounters per patient, p=0.011), walk‐in visits (0.61 versus 0.19 encounters per patient, p<0.001), and primary care phone calls in the 30‐days after discharge (1.66 versus 1.13 encounters per patient, p<0.001). Readmitted patients also had higher rates of ER visits, cardiology appointments, and use of a 24‐hour nursing help line (p<0.001 for all). There was no difference in phone calls with telemonitoring (p=0.7599).
Patients readmitted within 30‐days of hospital discharge with the primary diagnosis of congestive heart failure had higher rates of outpatient encounters and ER visits compared to patients who were not readmitted. This cross‐sectional survey suggests that outpatient resources are being utilized by patients who are readmitted following an initial admission for congestive heart failure. Further research is required to delineate the utility of different types of outpatient encounters and to better understand their individual effects on hospital readmission rates.
To cite this abstract:Horstman M, Stewart D, Spiegelman A, Trautner B, Naik A. Assessing the Impact of Outpatient Resources on Congestive Heart Failure Readmissions: Is It Enough?. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 112. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/assessing-the-impact-of-outpatient-resources-on-congestive-heart-failure-readmissions-is-it-enough/. Accessed April 10, 2020.