Association between post-hospital clinic and telephone follow-up provider visits with 30-day readmission risk in an integrated health system

Huong Q. Nguyen, Aileen Baecker, Timothy Ho, Dan N. Huynh, Heather L. Watson, Jing Li, Ernest Shen

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Follow-up visits with clinic providers after hospital discharge may not be feasible for some patients due to functional limitations, transportation challenges, need for physical distancing, or fear of exposure especially during the current COVID-19 pandemic. Methods: The aim of the study was to determine the effects of post-hospital clinic (POSH) and telephone (TPOSH) follow-up provider visits versus no visit on 30-day readmission. We used a retrospective cohort design based on data from 1/1/2017 to 12/31/2019 on adult patients (n = 213,513) discharged home from 15 Kaiser Permanente Southern California hospitals. Completion of POSH or TPOSH provider visits within 7 days of discharge was the exposure and all-cause 30-day inpatient and observation stay readmission was the primary outcome. We used matching weights to balance the groups and Fine-Gray subdistribution hazard model to assess for readmission risk. Results: Unweighted all-cause 30-day readmission rate was highest for patients who completed a TPOSH (17.3%) followed by no visit (14.2%), non-POSH (evaluation and management visits that were not focused on the hospitalization: 13.6%) and POSH (12.6%) visits. The matching weighted models showed that the effects of POSH and TPOSH visits varied across patient subgroups. For high risk (LACE 11+) medicine patients, both POSH (HR: 0.77, 95% CI: 0.71, 0.85, P <.001) and TPOSH (HR: 0.91, 95% CI: 0.83, 0.99, P =.03) were associated with 23 and 9% lower risk of 30-day readmission, respectively, compared to no visit. For medium to low risk medicine patients (LACE< 11) and all surgical patients regardless of LACE score or age, there were no significant associations for either visit type with risk of 30-day readmission. Conclusions: Post-hospital telephone follow-up provider visits had only modest effects on 30-day readmission in high-risk medicine patients compared to clinic visits. It remains to be determined if greater use and comfort with virtual visits by providers and patients as a result of the pandemic might improve the effectiveness of these encounters.

Original languageEnglish
Article number826
JournalBMC Health Services Research
Volume21
Issue number1
DOIs
StatePublished - Dec 2021

Bibliographical note

Funding Information:
We thank Ms. Janet Lee for her assistance in acquiring the data and Dr. Harun Kundi from the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts for sharing the frailty index code.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Care transition
  • Post-discharge provider follow-up
  • Readmission

ASJC Scopus subject areas

  • Health Policy

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