Key result
An EMR-based appointment order at hospital discharge significantly increased 90-day cardiovascular follow-up rates from 56.7% to 67.9% (OR 3.28) compared to the pre-order era.
Why the study?
Outpatient follow-up after discharge improves continuity of care and reduces readmissions, but rates remain low, and it is unknown whether EMR-based tools improve follow-up.
Does an EMR-based appointment order at hospital discharge improve 90-day cardiovascular follow-up rates and reduce 30-day readmission rates in cardiovascular medicine patients?
Observational (n=39,209)
No
Does an EMR-based appointment order at hospital discharge improve 90-day cardiovascular follow-up rates and reduce 30-day readmission rates in cardiovascular medicine patients?
Implementation of an EMR-based appointment order at hospital discharge significantly increased 90-day cardiology follow-up rates but was paradoxically associated with a slight increase in 30-day readmission rates.
Answers are grounded in this paper and cite their sources.
May facilitate cardiovascular follow-up via EMR prompts; leaves open questions of causality and scalability.
Outpatient follow-up after hospital discharge improves continuity of care and reduces readmissions, but rates of follow-up remain low. It is not known whether electronic medical record (EMR)-based tools improve follow-up. The aim of this study was to determine if an EMR-based order to secure cardiology follow-up appointments at hospital discharge would improve follow-up rates and hospital readmission rates. A pre-post interventional study was conducted and evaluated 39,209 cardiovascular medicine discharges within an academic center between 2012 and 2017. Follow-up rates and readmission rates were compared during 2 years prior to EMR-order implementation (pre-order era 2012-2013, n = 12,852) and 4 years after implementation (EMR-order era 2014-2017, n = 26,357). The primary endpoint was 90-day cardiovascular follow-up rates within our health system. In the overall cohort, the mean age of patients was 69.3 years [SD 14.7] and 60.7% (n = 23,827) were male. In the pre-order era, 90-day follow-up was 56.7 ± 0.4% (7286 of 12,852) and increased to 67.9 ± 0.3% (17,888 of 26,357, P < 0.001) in the EMR-order era. The use of the EMR follow-up order was independently associated with increased outpatient follow-up within 90 days after adjusting for patient demographics and payor status (OR 3.28, 95% CI 3.10-3.47, P < 0.001). The 30-day readmission rate in the pre-order era was 12.8% (1642 of 12,852) compared with 13.7% (3601 of 26,357, P = 0.016) in the EMR-order era. An EMR-based appointment order for follow-up appointment scheduling was associated with increased cardiovascular medicine follow-up, but was not associated with an observed reduction in 30-day readmission rates.
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Telukuntla et al. (2021) conducted an observational in Cardiovascular medicine hospital discharge (n=39,209). EMR-based appointment order vs. Pre-order era (standard care) was evaluated on 90-day cardiovascular follow-up rates within the health system (OR 3.28, 95% CI 3.10-3.47, p=<0.001). An EMR-based appointment order at hospital discharge significantly increased 90-day cardiovascular follow-up rates from 56.7% to 67.9% (OR 3.28) compared to the pre-order era.
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