SESSION TYPE: COPD: Outcomes
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Recent literature has noted the frequent lack of a follow-up physician visit after hospital discharge as a potential contributor to 30-day readmission rates. However, few studies are available about the effect of such visits on readmission rates. Further, many studies on the effect of follow-up visits on readmissions have not been disease specific, and have not considered patients by severity of illness. In this study we examined the relationship between 30-day readmission rates and follow-up visits with the patient’s primary care physician (PCP) and/ or a pulmonologist in COPD patients, a group with typically high readmissions.
METHODS: We conducted a retrospective cohort study of patients discharged from a tertiary academic center with a primary diagnosis of COPD between 2004 and 2011. The primary end points were readmission, ED visit and death, collectively termed as post-discharge failure (PDF). We performed a Pearson Chi square test with multivariate logistic regression to determine the adjusted odds ratio of 30-day PDF with and without follow-up. We also performed a similar subset analysis of unique patients and a single index hospitalization to limit the possible influence of high acuity subsets on the results for the full cohort.
RESULTS: 839 unique patients were discharged with a primary diagnosis of COPD during 1422 index hospitalizations. We performed multivariate logistic regression to adjust our results for age, gender, Charlton Comorbidity Index and Index length of stay. The occurrence of a follow-up visit within the first 30 days post discharge did not reduce the risk of readmission or emergency department visits in the study cohort (Adjusted OR 0.964, CI 0.745 - 1.249, p-value 0.784) or within a subset of patients who had a single hospital admission (Adjusted OR 0.821, CI 0.580 - 1.163, p-value 0.267) analysis. However, a significant reduction in mortality was associated with follow up visits in both the primary and subset cohorts (p-value <0.005). In addition the Charlson Comorbidity Index was significantly greater in patients who experienced PDF (p-value <0.0001).
CONCLUSIONS: Our results suggest that follow-up visits may not be useful for preventing 30-day readmissions in patients with a primary discharge diagnosis of COPD, which is consistent with some prior studies that suggest little or no benefit with follow-up visits. However, in this cohort of COPD patients a follow up visit significantly reduced 30 day mortality. These findings suggest that follow-up visits are beneficial for reducing 30 day mortality in COPD patients, but may not be beneficial or cost effective for reducing 30 day readmissions or emergency department visits. Alternative strategies or changing the nature or processes that occur during post-hospital follow-up visits appear to be warranted to prevent readmissions in COPD patients.
CLINICAL IMPLICATIONS: Our research provides rationale and motivation to better align and integrate inpatient and outpatient care for COPD patients.
DISCLOSURE: The following authors have nothing to disclose: Salman Fidahussein, David Klocke
No Product/Research Disclosure InformationMayo Clinic, Rochester, MN