Literature supports the positive impact of timely outpatient primary care follow‐up on reducing hospital readmissions. A post‐acute care clinic, staffed by hospitalists, housestaff or mid‐level providers, has emerged as a model for augmenting community PCP availability. The University of New Mexico Hospital (UNMH), an academic medical center and safety net hospital, established a Post‐Acute care Clinic (PAC) in February 2013, staffed by a nurse practitioner, with the goal of providing outpatient follow‐up within 2‐weeks of discharge to those patients who otherwise could not receive care in the community within this timeframe. This study focuses on: 1) comparing demographic and inpatient stay related variables between patients who attended their PAC visit and those that did not, 2) measuring the impact of PAC attendance on hospital readmissions and emergency department (ED) return visits and 3) identifying the frequency and type of PAC clinical interventions.
A retrospective chart review of the first 226 appointments made in the PAC was conducted for patients discharged from the medicine services at UNMH between February 1, 2013 to June 30, 2013. Two cohort groups were identified — those attending the clinic (“show”) and those not attending (“no show”). The two groups were compared by age, gender, language, substance abuse, homelessness, education, income, payor status, driving distance and hospital stay factors including length of stay (LOS), severity, case mix index (CMI) and cost. The 30‐day readmission rates and 30‐Day ED return visit rates were calculated. Differences between the groups were assessed for significance using either the chi‐squared statistic or two‐side t‐test.
Except for homelessness, the analysis of demographics and inpatient stay related variables did not identify any significant predictor for those patients less likely to attend the PAC after discharge. PAC attendance was associated with a 53% decrease in the 30‐day ED return rate (P < 0.05) and a 44% decrease in the 30‐day hospital readmission rate (P = 0.059). Almost 30% of PAC patients had medications adjusted during their visit while 25.7% of patients had new problems identified that were either treated or referred. It is possible that interventions made during the PAC visit played a role in reducing readmission and ED return visit rates in this group.
To cite this abstract:Wills J, Langsjoen J, Rego R, Collins N. Attendance in a Post‐Acute Care Clinic and 30‐Day Readmission and Emergency Department Return Visit Rates. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 160. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/attendance-in-a-postacute-care-clinic-and-30day-readmission-and-emergency-department-return-visit-rates/. Accessed September 16, 2019.