Key result
Follow-up in a hospitalist-run post-discharge clinic yielded similar 30-day adverse outcomes compared to primary care or urgent care, despite a shorter index length of stay (3.8 vs 6.2 days; p=0.04).
Why the study?
Does follow-up in a hospitalist-run post-discharge clinic reduce the composite of hospital readmissions, Emergency Department visits, and mortality at 30 days in Veterans discharged home after a nonscheduled admission compared to primary care or urgent care follow-up?
Cohort (n=5,085)
Does follow-up in a hospitalist-run post-discharge clinic reduce the composite of hospital readmissions, Emergency Department visits, and mortality at 30 days in Veterans discharged home after a nonscheduled admission compared to primary care or urgent care follow-up?
Answers are grounded in this paper and cite their sources.
A hospitalist-run post-discharge clinic achieved similar 30-day adverse outcome rates as primary or urgent care follow-up, despite facilitating a significantly shorter index hospital length of stay.
BACKGROUND: New post-discharge strategies to reduce adverse events are needed. OBJECTIVE: To determine whether follow-up in a hospitalist-run post-discharge clinic (PDC) decreases post-discharge adverse events when compared to follow-up in a primary care clinic (PCP) or urgent care clinic (UC). DESIGN: Retrospective cohort study using propensity scoring in multivariate analysis. PATIENTS: Consecutive Veterans discharged home after a nonscheduled admission seen in PDC, UC, or PCP within 30 days of discharge. INTERVENTIONS: Recently discharged patients are seen by housestaff who cared for them during the index admission and staffed with a rotating hospitalist in PDC; UC and PCP patients are seen by housestaff or attending ambulatory physicians. MAIN MEASURES: The primary outcome was a composite of hospital readmissions, Emergency Department visits, and mortality 30 days after discharge. KEY RESULTS: 5085 patients met criteria; 538 followed up in PDC (10.6%), 1848 with their PCP (36.3%), and 2699 in UC (53.1%). Patients following up in PDC were older and had a higher comorbidity burden. ICU exposure was similar between groups. Patients seen in PDC had shorter length of stay (LOS) (PDC, 3.8 days, UC, 5.0 days, PCP, 6.2 days; p = 0.04) and time to first post-discharge visit (PDC, 5.0 days, UC, 9.4 days, PCP, 13.7 days; p < 0.01). There were no differences between groups in the primary outcome in unadjusted or propensity-adjusted multivariate analysis. CONCLUSIONS: Patients seen in a hospitalist-run PDC had similar 30-day post-discharge adverse outcome rates despite a 2.4-day shorter LOS compared to patients seen by their PCP. Prospective testing of PDCs is warranted.
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Burke et al. (2013) conducted a cohort in Recently discharged after a nonscheduled admission (n=5,085). Hospitalist-run post-discharge clinic (PDC) vs. Primary care clinic (PCP) or urgent care clinic (UC) was evaluated on Composite of hospital readmissions, Emergency Department visits, and mortality 30 days after discharge. Follow-up in a hospitalist-run post-discharge clinic yielded similar 30-day adverse outcomes compared to primary care or urgent care, despite a shorter index length of stay (3.8 vs 6.2 days; p=0.04).
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