The transition between inpatient and outpatient settings is known to be a period of high risk for adverse events such as medication and laboratory‐monitoring errors. Readmission rates, up to 20% after 30 days among Medicare beneficiaries, may signal failures in posthospital care. In particular, discharged patients lacking primary care provider (PCP) follow‐up may have unmet needs. Few studies have examined the scope of inadequate follow‐up for patients discharged from the hospital. This study evaluated characteristics and outcomes of discharged patients lacking timely PCP follow‐up.
This prospective cohort enrolled 65 patients admitted over 4 consecutive months to general medical ward teams at the University of Colorado Hospital, an urban 425‐bed tertiary‐care center. We collected data on patient demographics, diagnosis, and payer source. Patients were interviewed about prehospital PCP status, frequency of PCP visits, and barriers to obtaining PCP care. Follow‐up phone calls were made 4 weeks postdischarge to determine timing of any 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 overall rate of PCP follow‐up within 30 days was 49.2%. For a patient's same medical condition, the overall 30‐day readmission rate was 14.8% but significantly higher (24%) among patients lacking timely PCP follow‐up compared with patients with timely PCP follow‐up (3%), P = 0.03. Patients lacking timely PCP follow‐up were nearly 10 times more likely to be readmitted for the same condition (OR = 9.9, P = 0.04). Lack of insurance was associated with lower rates of timely PCP follow‐up, as only 5 of 17 uninsured patients (29.4%) had PCP follow‐up within 30 days (P = 0.06), compared with 27 of 48 insured patients (56.3%). However, lack of insurance 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 versus 6.3 days, P = 0.11.
Significant numbers of patients discharged from the hospital lacked timely outpatient PCP follow‐up in this single, large, urban academic hospital. Patients without follow‐up had higher rates of readmission and a nonsignificant trend toward longer hospital length of stay. Effective transitioning of care for discharged patients, particularly those without insurance, may require timely PCP follow‐up.
G. Misky, none; E. Coleman, none; H. Wald, none.
To cite this abstract:Misky G, Wald H, Coleman E. Transitions to No Care: Patients Lack Timely Posthospital Follow‐Up. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 69. https://www.shmabstracts.com/abstract/transitions-to-no-care-patients-lack-timely-posthospital-followup/. Accessed December 10, 2018.