Scheduling early primary care follow‐up after pneumonia: A retrospective target trial emulation in five hospitals

Background Current guidelines make no recommendations on discharge interventions or scheduling outpatient follow‐up after hospitlization for commnity‐acquired pneumonia (CAP). Objectives To assess the impact of scheduling early primary care follow‐up prior to discharge home among survivors of hypoxemic CAP hospitalizations. Methods We conducted an observational target trial emulation of 3332 adults (age ≥18 years) with hypoxemic CAP (requiring ≥2 liters oxygen) admitted to a 5‐hospital system and discharged home between 2019 and 2024. Treated and control patients were propensity score‐matched with replacement on 30 prespecified confounders. Treated patients had early primary care follow‐up (to occur within 14 days of discharge) scheduled predischarge. The Average Treatment effect on the Treated (ATT) on a primary composite outcome of postdischarge mortality or readmission was assessed 90 days postdischarge. Results After weighting, the matched cohort included 894 patients with equal treated and control groups (median age 66 [interquartile range [IQR]: 54–77]). Treated patients completed 14‐day follow‐up more frequently compared with controls (85% vs. 36%). The observed reduction in the incidence of the primary outcome in the treated group was not statistically significant (ATT: −1.1% [CI: −7.3, 5.1], p = 0.72). In a post‐hoc analysis of 301 treated patients who subsequently completed scheduled follow‐up, there was a statistically significant reduction in the incidence of the primary outcome in the treated group (ATT: −7.0% [CI: −13.9, –0.01], p = 0.049). Conclusion Scheduling early primary care follow‐up after hospitalization for hypoxemic CAP was associated with reduced 90‐day readmission and mortality only among patients who completed follow‐up. Future work is needed to enhance the completion of scheduled primary care follow‐up for hypoxemic CAP survivors.