NEW YORK (Reuters Health) Heart failure patients who see a physician within a week after hospital discharge are less likely to be readmitted within 30 days, according to a study published May 5th in the Journal of the American Medical Association.
Hospital readmission is “a national problem with heart failure as a prime example,î lead author Dr. Adrian F. Hernandez of Duke University School of Medicine in Durham, North Carolina told Reuters Health by email. Early follow-up after discharge has been suggested as a potential way to reduce readmission.”
To determine how early physician follow-up affects readmission rates, Dr. Hernandez and colleagues analyzed data on 30,136 Medicare patients, aged 65 and older, who were hospitalized for heart failure and sent home after a median of 4 days.
The 225 participating hospitals were part of the OPTIMIZE-HF quality improvement program, which ran from 2003 through 2006.
In the first 30 days after discharge, 6,483 patients (21.3%) were readmitted.
Early follow-up (within one week of discharge) was not the norm. At the hospital level, a median of only 38.3% of patients saw a physician for outpatient evaluation and management within a week of hospital discharge.
But, Dr. Hernandez said, “Hospitals with more consistent early follow-up had lower readmission rates, independent of who provided it. It didn’t seem to matter whether it was a cardiologist or an internist who did the follow-up simply following up early was associated with lower readmission, he said.
Specifically, the unadjusted 30-day readmission rate was highest (23.3%) among patients in hospitals in the lowest quartile of early follow up. The rates were 20-21% for patients from hospitals in the top quartile.
Compared to the lowest quartile of early follow-up rates, the adjusted hazard ratio for 30-day readmission or mortality for patients discharged from second, third or fourth-quartile hospitals were 0.85, 0.87, and 0.91, respectively.
“Early evaluation after discharge is critical,” Dr. Hernandez and colleagues conclude. “This should include a review of therapeutic changes and a thorough assessment of the patient’s clinical status outside of the highly structured hospital setting.”
“What hospitals can do,” Dr. Hernandez told Reuters Health, “is establish systems of care that improve the transition of care from inpatient to outpatient, establish early follow-up and provide a safety net for patients who either can’t come in early after discharge or miss their appointment.”
Dr. Alfred A. Bove, immediate past president of the American College of Cardiology (ACC) and emeritus professor of medicine at Temple University, Philadelphia said in a statement, “Until now, early follow-up for heart failure patients after discharge had face validity only. This study confirms the importance of establishing coordinated systems of care in which patients are evaluated early after discharge.”
Dr. Bove also noted that early follow-up of heart failure patients who are discharged is one of three core concepts of the ACC’s national quality improvement initiative Hospital to Home (H2H), for reducing readmissions.
“Discharged patients should have a follow-up visit scheduled within one week of discharge, as well as the means of getting to that appointment. Providing support during the transition from inpatient to outpatient status is essential, he said.
Reference:
JAMA 2010;303:1716-1722.
