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Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up†
Article first published online: 23 JUN 2010
Copyright © 2010 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 5, Issue 7, pages 392–397, September 2010
How to Cite
Misky, G. J., Wald, H. L. and Coleman, E. A. (2010), Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up. J. Hosp. Med., 5: 392–397. doi: 10.1002/jhm.666
Disclosure: Nothing to report.
- Issue published online: 9 SEP 2010
- Article first published online: 23 JUN 2010
- Manuscript Accepted: 31 DEC 2009
- Manuscript Revised: 4 NOV 2009
- Manuscript Received: 1 MAY 2009
- continuity of hospital care;
- post-hospital PCP follow-up;
- transitions of care
The transition between the inpatient and outpatient setting is a high-risk period for patients. The presence and role of the primary care provider (PCP) is critical during this transition. This study evaluated characteristics and outcomes of discharged patients lacking timely PCP follow-up, defined as within 4 weeks of discharge.
This prospective cohort enrolled 65 patients admitted to University of Colorado Hospital, an urban 425-bed tertiary care center. We collected patient demographics, diagnosis, payer source and PCP information. Post-discharge phone calls determined PCP follow-up and readmission status. Thirty-day readmission rate and hospital length of stay (LOS) were compared in patients with and without timely PCP follow-up.
The rate of timely PCP follow-up was 49%. For a patient's same medical condition, the 30-day readmission rate was 12%. Patients lacking timely PCP follow-up were 10 times more likely to be readmitted (odds ratio [OR] = 9.9, P = 0.04): 21% in patients lacking timely PCP follow-up vs. 3% in patients with timely PCP follow-up, P = 0.03. Lack of insurance was associated with lower rates of timely PCP follow-up: 29% vs. 56% (P = 0.06), but did not independently increase readmission rate or LOS (OR = 1.0, P = 0.96). Index hospital LOS was longer in patients lacking timely PCP follow-up: 4.4 days vs. 6.3 days, P = 0.11.
Many patients discharged from this large urban academic hospital lacked timely outpatient PCP follow-up resulting in higher rates of readmission and a non-significant trend toward longer hospital LOS. Effective transitioning of care for vulnerable patients may require timely PCP follow-up. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.