Posthospital follow-up visits and 30-day readmission rates in chronic obstructive pulmonary disease
Salman S Fidahussein,1 Ivana T Croghan,2 Stephen S Cha,3 David L Klocke4
1Department of Pulmonary and Critical Care Medicine, Norwalk Hospital, Norwalk, CT, 2Department of Medicine Clinical Research Office, 3Department of Health Sciences Research, 4Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Purpose: To examine the effect of a follow-up visit with a primary care physician and/or pulmonologist within the first 30 days of hospital discharge on readmissions, emergency department (ED) visits, and mortality.
Patients and methods: This was a retrospective cohort study of 7,102 unique patients discharged from a Mayo Clinic hospital in Rochester, MN, and residing in Olmsted County, MN, with any mention of chronic obstructive pulmonary disease (COPD) from January 1, 2004 through November 30, 2011. The study included 839 patients who met study-entry criteria. Cox proportional hazards regression was performed to determine the risk of hospital readmission, ED visits, and death of patients, with or without a follow-up visit during the first 30 days postdischarge.
Results: Our results showed 839 unique patients experienced 1,422 discharges with a primary diagnosis of COPD. Of the 1,422 discharges, 973 (68.4%) had a follow-up visit within 30 days. In a multivariate Cox proportional hazard-ratio (HR) model analysis, occurrence of a follow-up visit did not have a significant effect on the risk of the combined outcome of 30-day readmission and ED visit (HR 0.947, confidence interval 0.763–1.177; P=0.63). However, a postdischarge follow-up visit had a significant effect on 30-day mortality (HR 0.279, confidence interval 0.149–0.523; P<0.001).
Conclusion: Postdischarge follow-up visits after hospitalization for COPD did not significantly reduce the risk of 30-day readmission or ED visit. However, patients who received postdischarge follow-up visits had significantly reduced 30-day mortality.
Keywords: care transitions, COPD, discharge planning, outpatient follow-up, risk factors
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