May 5, 2010

Higher Rate Of Early Follow-up For Heart Failure Patients Linked With Lower Rate Of Readmissions

Hospitals that have a higher rate of following up within one week for patients who were discharged after treatment for heart failure have a lower rate of readmission at 30 days for these patients, according to a study in the May 5 issue of JAMA.

"Clinicians, payers, and policy makers seeking to promote efficiency and quality in health care are targeting hospital readmission rates. One-fifth of Medicare beneficiaries are rehospitalized within 30 days and more than one-third within 90 days," the authors write. Heart failure is the most common diagnosis associated with 30-day readmission among Medicare beneficiaries. "Early outpatient follow-up after hospitalization has been proposed as a means of reducing readmission rates. However, there are limited data describing patterns of follow-up after heart failure hospitalization and its association with readmission rates."

Adrian F. Hernandez, M.D., M.H.S., of the Duke University School of Medicine, Durham, N.C., and colleagues examined hospital-level variation in postdischarge physician follow-up and the relationship between rates of early follow-up (within 7 days after discharge) and patient outcomes. The study included Medicare patients 65 years or older who were admitted for heart failure and discharged to home from hospitals participating in a quality improvement program from January 2003 through December 2006. The study population included 30,136 patients from 225 hospitals. Median (midpoint) length of hospital stay was 4 days.

In the first 30 days after discharge, 6,428 patients (21.3 percent) were readmitted. At the hospital level, the median rate of early follow-up was 38.3 percent. "Compared with patients whose index admission was in a hospital in the lowest quartile of early follow-up (30-day readmission rate, 23.3 percent), the rates of 30-day readmission were 20.5 percent among patients in the second quartile, 20.5 percent among patients in the third quartile, and 20.9 percent among patients in the fourth quartile," the authors write.

Discharge from hospitals in which a greater proportion of patients received early follow-up was independently associated with lower rates of all-cause 30-day readmission.

"Early evaluation after discharge is critical. This evaluation should include a review of therapeutic changes and a thorough assessment of the patient's clinical status outside of the highly structured hospital setting," the authors write.

"Our findings highlight a need for improvement and greater uniformity in coordination of care from inpatient to outpatient settings."

(JAMA. 2010;303[17]:1716-1722)


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