Continuity of Care and Patient Outcomes After Hospital Discharge

Authors

  • Carl Van Walraven MD, MSc,

    Corresponding author
      Address correspondence and requests for reprints to Dr. van Walraven: Clinical Epidemiology Unit, Ottawa Health Research Institute, F-6, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada (e-mail: carlv@ohri.ca).
    Search for more papers by this author
  • Muhammad Mamdani PharmD, MA, MPH,

  • Jiming Fang PhD,

  • Peter C. Austin PhD


  • Received from the Faculty of Medicine (CVW), University of Ottawa; Clinical Epidemiology Program (CVW), Ottawa Health Research Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences (CVW, MM, JF, PCA); and Faculties of Medicine (PCA) and Pharmacy (MM), University of Toronto, Toronto, Ontario, Canada.

Address correspondence and requests for reprints to Dr. van Walraven: Clinical Epidemiology Unit, Ottawa Health Research Institute, F-6, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada (e-mail: carlv@ohri.ca).

Abstract

BACKGROUND:  Patients are often treated in hospital by physicians other than their regular community doctor. After they are discharged, their care is often returned to their regular community doctor and patients may not see the hospital physician. Transfer of information between physicians can be poor. We determined whether early postdischarge outcomes changed when patients were seen after discharge by physicians who treated them in the hospital.

METHODS:  This cohort study used population-based administrative databases to follow 938,833 adults from Ontario, Canada, after they were discharged alive from a nonelective medical or surgical hospitalization between April 1, 1995, and March 1, 2000. We determined when patients were seen after discharge by physicians who treated them in the hospital, physicians who treated them 3 months prior to admission (community physicians), and specialists. The outcome of interest was 30-day death or nonelective readmission to hospital.

RESULTS:  Of patients studied, 7.7% died or were readmitted. The adjusted relative risk of death or readmission decreased by 5% (95% confidence interval [CI], 4% to 5%) and 3% (95% CI, 2% to 3%) with each additional visit to a hospital physician rather than a community physician or specialist, respectively. The effect of hospital physician visits was cumulative, with the adjusted risk of 30-day death or nonelective readmission reduced to 7.3%, 7.0%, and 6.7% if patients had 1, 2, or 3 visits, respectively, with a hospital rather than a community physician. The effect was consistent across important subgroups.

CONCLUSIONS:  Patient outcomes could be improved if their early postdischarge visits were with physicians who treated them in hospital rather than with other physicians. Follow-up visits with a hospital physician, rather than another physician, could be a modifiable factor to improve patient outcomes following discharge from hospital.

Ancillary