Fasiha Kanwal1,2,3, Steven M Asch4,5, Jennifer R Kramer1,3, Yumei Cao1,3, Sumeet Asrani6, Hashem B El-Serag1,2,3. 1. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. 2. Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. 3. Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX. 4. Center for Innovation to Implementation (Ci2i), Palo Alto Veterans Affairs Medical Center, Palo Alto, CA. 5. Division of General Medical Disciplines, Stanford University, Palo Alto, CA. 6. Section of Hepatology and Liver Transplantation, Baylor University, Dallas, TX.
Abstract
UNLABELLED: Preventing readmission has been the focus of numerous quality improvement efforts across many conditions. Early outpatient follow-up has been proposed as the best mechanism for reducing readmissions. The extent to which early outpatient follow-up averts readmission or improves outcomes in cirrhosis is not known. We evaluated the relationship between early outpatient follow-up and short-term readmission and mortality in patients with cirrhosis. We conducted a retrospective cohort study of patients with cirrhosis who were hospitalized with a liver-related diagnosis and discharged to home from 122 Veterans Administration hospitals between 2010 and 2013. We defined early follow-up as an outpatient visit with a clinician within 7 days after discharge. We propensity matched patients who received early visit with those who did not have any visit and examined the associations between early follow-up and all-cause readmission and mortality within 8-30 days after discharge. Of 25,217 patients hospitalized with cirrhosis, 8,123 (32.2%) had an early follow-up visit within 7 days of discharge. A total of 3,492 (13.8%) patients were readmitted and 1,185 (4.6%) died between 8 and 30 days after discharge. In the propensity-matched sample (N = 16,238), patients with early outpatient follow-up visit had a slightly higher risk of readmission (15.3% vs. 13.8%; hazard ratio [HR] =1.10; 95% confidence interval [CI] = 1.02-1.19), but significantly lower risk of mortality (3.2% vs. 5.2%; HR = 0.60; 95% CI = 0.51-0.70) than those without early visit. The findings persisted in several subgroup and sensitivity analyses. CONCLUSIONS: Early outpatient follow-up after discharge was associated with a small increase in readmissions but lower overall mortality in patients with cirrhosis. Transitional care may be effective in improving short-term outcomes in patients with cirrhosis, but readmission performance measures would miss this effect. (Hepatology 2016;64:569-581).
UNLABELLED: Preventing readmission has been the focus of numerous quality improvement efforts across many conditions. Early outpatient follow-up has been proposed as the best mechanism for reducing readmissions. The extent to which early outpatient follow-up averts readmission or improves outcomes in cirrhosis is not known. We evaluated the relationship between early outpatient follow-up and short-term readmission and mortality in patients with cirrhosis. We conducted a retrospective cohort study of patients with cirrhosis who were hospitalized with a liver-related diagnosis and discharged to home from 122 Veterans Administration hospitals between 2010 and 2013. We defined early follow-up as an outpatient visit with a clinician within 7 days after discharge. We propensity matched patients who received early visit with those who did not have any visit and examined the associations between early follow-up and all-cause readmission and mortality within 8-30 days after discharge. Of 25,217 patients hospitalized with cirrhosis, 8,123 (32.2%) had an early follow-up visit within 7 days of discharge. A total of 3,492 (13.8%) patients were readmitted and 1,185 (4.6%) died between 8 and 30 days after discharge. In the propensity-matched sample (N = 16,238), patients with early outpatient follow-up visit had a slightly higher risk of readmission (15.3% vs. 13.8%; hazard ratio [HR] =1.10; 95% confidence interval [CI] = 1.02-1.19), but significantly lower risk of mortality (3.2% vs. 5.2%; HR = 0.60; 95% CI = 0.51-0.70) than those without early visit. The findings persisted in several subgroup and sensitivity analyses. CONCLUSIONS: Early outpatient follow-up after discharge was associated with a small increase in readmissions but lower overall mortality in patients with cirrhosis. Transitional care may be effective in improving short-term outcomes in patients with cirrhosis, but readmission performance measures would miss this effect. (Hepatology 2016;64:569-581).
Authors: Joshua M Bauml; Ravi Vinnakota; Yeun-Hee Anna Park; Susan E Bates; Tito Fojo; Charu Aggarwal; Sewanti Limaye; Nevena Damjanov; Jessica Di Stefano; Christine Ciunci; Eric M Genden; Juan P Wisnivesky; Rocco Ferrandino; Ronac Mamtani; Corey J Langer; Roger B Cohen; Keith Sigel Journal: J Natl Cancer Inst Date: 2019-05-01 Impact factor: 13.506
Authors: Jejo D Koola; Sam B Ho; Aize Cao; Guanhua Chen; Amy M Perkins; Sharon E Davis; Michael E Matheny Journal: Dig Dis Sci Date: 2019-09-17 Impact factor: 3.199
Authors: Ayse L Mindikoglu; Ruben Hernaez; Yan Liu; Jennifer R Kramer; Thomas Taylor; Abbas Rana; Fasiha Kanwal Journal: Clin Gastroenterol Hepatol Date: 2019-11-25 Impact factor: 11.382
Authors: Marina Serper; David E Kaplan; Justine Shults; Peter P Reese; Lauren A Beste; Tamar H Taddei; Rachel M Werner Journal: Hepatology Date: 2019-06-26 Impact factor: 17.425
Authors: Adeyinka C Adejumo; George Cholankeril; Umair Iqbal; Eric R Yoo; Brian C Boursiquot; Waldo C Concepcion; Donghee Kim; Aijaz Ahmed Journal: Dig Dis Sci Date: 2019-08-01 Impact factor: 3.199