Key result
Community follow-up with both home care and a primary care physician visit within 7 days of discharge significantly reduced the risk of acute care hospitalization within one year compared to no follow-up (HR 0.38).
Why the study?
Does community follow-up within 7 days of discharge reduce subsequent acute care hospitalizations and ED visits in young and mid-life adults discharged from chronic care hospitals?
Cohort (n=1,906)
Does community follow-up within 7 days of discharge reduce subsequent acute care hospitalizations and ED visits in young and mid-life adults discharged from chronic care hospitals?
Hazard Ratio: 0.38 (95% CI 0.26–0.53)
Absolute Event Rate: 42.4% vs 61%
p-value: p=<.0001
Immediate community follow-up with both home care and a primary care physician within 7 days of discharge from chronic care hospitals is associated with delayed subsequent acute care hospitalizations in medically complex young and mid-life adults.
Combined early follow-up was associated with lower rehospitalization risk; leaves open whether randomized trials will confirm benefit before practice change.
BACKGROUND: Despite the demand for rehabilitation and chronic care services across the life course, policy and care strategies tend to focus on older adults and overlook medically complex younger adult populations. This study examined young and mid-life adults discharged from tertiary chronic care hospitals in order to describe their health service use and to examine the association between patterns of timely community follow-up, and subsequent health outcomes. METHODS: This population-based retrospective cohort study used linked administrative data to identify 1,906 individuals aged 18-64 years and discharged alive from tertiary chronic care hospitals in Ontario, Canada between April 1, 2005 and March 31, 2006. Multivariate Cox proportional hazard models were used to examine the effect of community follow-up within 7 days of discharge (home care and/or a primary care physician visit or neither) on time to first hospitalization and emergency department (ED) visit. Five-year survival was examined using Kaplan-Meier survival curves. RESULTS: The cohort had a high prevalence of multi-morbidity and use of hospital, emergency services and physician services was high in the year following discharge. Most individuals received follow-up care from a primary care physician and/or home care within 7 days of discharge while 30 % received neither. Within 1 year of discharge, 18 % of individuals died. Among those who survived, time to acute care hospitalization in the year following discharge was significantly longer among those who received both a home care and a physician follow-up visit compared to those who received neither. No significant associations were found between community follow-up and ED visits within 1 year. CONCLUSIONS: Immediate community follow-up may reduce subsequent use of acute care services. Future research should determine why some individuals, who would likely benefit from services, are not receiving them including barriers to access.
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Kuluski et al. (2016) conducted a cohort in Complex care needs (n=1,906). Community follow-up within 7 days (home care and primary care physician visit) vs. No community follow-up within 7 days was evaluated on Time to first acute care hospitalization within 1 year (HR 0.38, 95% CI 0.26-0.53, p=<.0001). Community follow-up with both home care and a primary care physician visit within 7 days of discharge significantly reduced the risk of acute care hospitalization within one year compared to no follow-up (HR 0.38).
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