Hospital discharge is a vulnerable moment for patients, and poor primary care access threatens followup. New models that include hospitalists in postdischarge care could improve postdischarge access.
The Post Discharge Clinic (PDC), a hospitaliststaffed clinic based in a large academic ambulatory practice, was established to create access to outpatient follow up for patients after hospital discharge. This abstract will describe the patient and practice characteristics of the clinic and its effects on access to care.
BIDMC is a 618bed academic medical center. Health Care Associates (HCA) is the primary care practice that houses >40 faculty members and >100 medical residents. We instituted the PDC in 9/2009. It is staffed by one of 4 dedicated hospitalists at a time, during which the hospitalist has no inpatient responsibilities. An algorithm schedules patients with their primary care provider (PCP), but defaults to the PDC when no PCP visits are available. Visits are 40 minutes, and the visit documentation is electronically forwarded to the PCP. We used generalized estimating equations to evaluate 1) differences in the duration from discharge to first clinic visit between patients seen in the PDC and elsewhere in HCA and 2) the overall proportion of HCA patients seen within a week after discharge when the PDC was open or closed.
The table demonstrates that the PDC saw a patient population comparable to postdischarge visits in the rest of HCA, with an overrepresentation of African Americans and patients with Medicaid (P < 0.001). Coding for visits was shifted to higher acuity in the PDC. The median duration from hospitalization to first visit was 7 days in the PDC and 15 days elsewhere in HCA (adjusted difference = 8.45 [pm] 0.43 days; P < 0.001). From 2009 to 2011, among 10,845 discharges of HCA patients, patients were more likely to be seen within a week when the PDC was open than when it was closed (Figure; adjusted odds ratio 1.41; 95% CI 1.251.57). Patients seen in a PDC based in a large academic primary care practice had far earlier followup than those seen elsewhere in the same practice, leading to a substantially greater proportion of all patients in the practice being seen within a week of discharge. The PDC also served a particularly high proportion of African Americans. If confirmed elsewhere, the use of a PDC may improve hospitalclinic transitions and reduce preventable readmissions.
To cite this abstract:Vanka A, McNally D, Mukamal K, Doctoroff L, Yu R. Improving Access with a Hospitaliststaffed Post Discharge Clinic. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97710. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/improving-access-with-a-hospitaliststaffed-post-discharge-clinic/. Accessed April 4, 2020.