Rahul Banerjee1, Alex Suarez2, Melanie Kier2, Steve Honeywell2, Weiwei Feng3, Nandita Mitra3, David Grande1,2, Jennifer Myers1. 1. Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 3. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND: Postdischarge follow-up visits (PDFVs) are widely recommended to improve inpatient-outpatient transitions of care. OBJECTIVE: To measure PDFV attendance rates. DESIGN: Observational cohort study. SETTING: Medical units at an academic quaternary-care hospital and its affiliated outpatient clinics. PATIENTS: Adult patients hospitalized between April 2014 and March 2015 for whom at least 1 PDFV with our health system was scheduled. Exclusion criteria included nonprovider visits, visits cancelled before discharge, nonaccepted health insurance, and visits scheduled for deceased patients. MEASUREMENTS: The study outcome was the incidence of PDFVs resulting in no-shows or same-day cancellations (NS/SDCs). RESULTS: Of all hospitalizations, 6136 (52%) with 9258 PDFVs were analyzed. Twenty-five percent of PDFVs were NS/SDCs, 23% were cancelled before the visit, and 52% were attended as scheduled. In multivariable regression models, NS/SDC risk factors included black race (odds ratio [OR] 1.94, 95% confidence interval [CI], 1.63-2.32), longer lengths of stay (hospitalizations ≥15 days: OR 1.51, 95% CI, 1.22- 1.88), and discharge to facility (OR 2.10, 95% CI, 1.70-2.60). Conversely, NS/SDC visits were less likely with advancing age (age ≥65 years: OR 0.39, 95% CI, 0.31-0.49) and driving distance (highest quartile: OR 0.65, 95% CI, 0.52-0.81). Primary care visits had higher NS/SDC rates (OR 2.62, 95% CI, 2.03-3.38) than oncologic visits. The time interval between discharge and PDFV was not associated with NS/SDC rates. CONCLUSIONS: PDFVs were scheduled for more than half of hospitalizations, but 25% resulted in NS/SDCs. New strategies are needed to improve PDFV attendance.
BACKGROUND: Postdischarge follow-up visits (PDFVs) are widely recommended to improve inpatient-outpatient transitions of care. OBJECTIVE: To measure PDFV attendance rates. DESIGN: Observational cohort study. SETTING: Medical units at an academic quaternary-care hospital and its affiliated outpatient clinics. PATIENTS: Adult patients hospitalized between April 2014 and March 2015 for whom at least 1 PDFV with our health system was scheduled. Exclusion criteria included nonprovider visits, visits cancelled before discharge, nonaccepted health insurance, and visits scheduled for deceased patients. MEASUREMENTS: The study outcome was the incidence of PDFVs resulting in no-shows or same-day cancellations (NS/SDCs). RESULTS: Of all hospitalizations, 6136 (52%) with 9258 PDFVs were analyzed. Twenty-five percent of PDFVs were NS/SDCs, 23% were cancelled before the visit, and 52% were attended as scheduled. In multivariable regression models, NS/SDC risk factors included black race (odds ratio [OR] 1.94, 95% confidence interval [CI], 1.63-2.32), longer lengths of stay (hospitalizations ≥15 days: OR 1.51, 95% CI, 1.22- 1.88), and discharge to facility (OR 2.10, 95% CI, 1.70-2.60). Conversely, NS/SDC visits were less likely with advancing age (age ≥65 years: OR 0.39, 95% CI, 0.31-0.49) and driving distance (highest quartile: OR 0.65, 95% CI, 0.52-0.81). Primary care visits had higher NS/SDC rates (OR 2.62, 95% CI, 2.03-3.38) than oncologic visits. The time interval between discharge and PDFV was not associated with NS/SDC rates. CONCLUSIONS: PDFVs were scheduled for more than half of hospitalizations, but 25% resulted in NS/SDCs. New strategies are needed to improve PDFV attendance.
Authors: Eric Bressman; Rachel M Werner; Claiborne Childs; Amanda Albrecht; Jennifer S Myers; Srinath Adusumalli Journal: J Gen Intern Med Date: 2022-01-11 Impact factor: 6.473