What question did this study set out to answer?

This study aims to evaluate how early follow-up visits with primary care providers affect 30-day emergency department visits and readmissions in COPD patients.

October 11, 2010Open Access

Outpatient Follow-up Visit and 30-Day Emergency Department Visit and Readmission in Patients Hospitalized for Chronic Obstructive Pulmonary Disease

Key Points

This study aims to evaluate how early follow-up visits with primary care providers affect 30-day emergency department visits and readmissions in COPD patients.
Retrospective cohort analysis of fee-for-service Medicare beneficiaries hospitalized for COPD between 1996 and 2006.
Established PCP for patients with three or more visits in the year preceding hospitalization.
Used Cox proportional hazard regression to assess 30-day ER visit and readmission risks based on follow-up visits.
66.9% of patients had a follow-up visit within 30 days of discharge.
Follow-up visits reduced risk of ER visits (HR 0.86; 95% CI 0.83-0.90) and readmissions (HR 0.91; 95% CI 0.87-0.96).
Factors influencing follow-up visits included length of stay, prior hospitalizations, age, race, socioeconomic status, and hospital type.

Abstract

BACKGROUND: Readmissions in patients with chronic obstructive pulmonary disease (COPD) are common and costly. We examined the effect of early follow-up visit with patient's primary care physician (PCP) or pulmonologist following acute hospitalization on the 30-day risk of an emergency department (ER) visit and readmission. METHODS: We conducted a retrospective cohort study of fee-for-service Medicare beneficiaries with an identifiable PCP who were hospitalized for COPD between 1996 and 2006. Three or more visits to a PCP in the year prior to the hospitalization established a PCP for a patient. We performed a Cox proportional hazard regression with time-dependent covariates to determine the risk of 30-day ER visit and readmission in patients with or without a follow-up visit to their PCP or pulmonologist. RESULTS: Of the 62 746 patients admitted for COPD, 66.9% had a follow-up visit with their PCP or pulmonologist within 30 days of discharge. Factors associated with lower likelihood of outpatient follow-up visit were longer length of hospital stay, prior hospitalization for COPD, older age, black race, lower socioeconomic status, and emergency admission. Those receiving care at nonteaching, for-profit, and smaller-sized hospitals were more likely to have a follow-up visit. In a multivariate, time-dependent analysis, patients who had a follow-up visit had a significantly reduced risk of an ER visit (hazard ratio HR, 0.86; 95% confidence interval CI, 0.83-0.90) and readmission (HR, 0.91; 95% CI, 0.87-0.96). CONCLUSION: Continuity with patient's PCP or pulmonologist after an acute hospitalization may lower rates of ER visits and readmission in patients with COPD.

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