Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort study

Bryan Borg,Angela Keniston,Marc Moss,Ivor S Douglas,Madelyne Hull,Brendan J Clark

doi:10.1186/s13722-018-0125-1

Abstract

PurposePatients with alcohol misuse are less likely to receive preventive health services but more likely to utilize emergency health services. However, the association between alcohol misuse and outpatient follow-up after hospitalization is unknown and may depend on whether a patient experiences a critical illness. We sought to determine whether alcohol misuse was associated with lower rates of outpatient follow-up after hospital discharge and whether the magnitude of this association differed in patients who experienced a critical illness.Materials and methodsThis was a retrospective cohort study using administrative data from an urban safety net hospital. Patients were included if they were admitted between 2011 and 2015, were between the ages of 18 and 89, resided within the safety net county, were discharged home, and were at moderate to high risk for hospital readmission within the subsequent 30 days. Alcohol misuse was identified using a combination of ICD-9 codes and response to a single screening question. The primary outcome was a combined measure of follow-up with a primary care physician or specialist provider in the 30 days following hospital discharge. Multivariable logistic regression was used to adjust for factors known to be associated with healthcare utilization.ResultsOverall, 17,575 patients were included in the analysis; 4984 (28%) had alcohol misuse. In the 30 days following hospital discharge, 46% of patients saw any outpatient provider. In an unadjusted analysis, the association between alcohol misuse and attending any outpatient follow-up was dependent on whether patients had a critical illness (p value < 0.0001) with the highest rates of follow-up in survivors of critical illness without alcohol misuse (53%, 95% CI 51%, 55%) followed by patients without alcohol misuse or critical illness (49%; 95% CI 48%, 50%), patients with alcohol misuse without critical illness (38%; 95% CI 36%, 39%), and patients with alcohol misuse and a critical illness (37%; 95% CI 35%, 40%). Adjusting for factors associated with healthcare utilization, these findings were modestly attenuated but unchanged.ConclusionsPatients with alcohol misuse who are at moderate to high risk for hospital readmission may benefit from targeted interventions to increase rates of outpatient follow-up after hospital discharge.

Highlights

The spectrum ranging from excessive alcohol use without consequences to the presence of an alcohol use disorder (AUD) is referred to as alcohol misuse [1]
The association between alcohol misuse and attending any outpatient follow-up was dependent on whether patients had a critical illness (p value < 0.0001) with the highest rates of follow-up in survivors of critical illness without alcohol misuse (53%, 95% CI 51%, 55%) followed by patients without alcohol misuse or critical illness (49%; 95% CI 48%, 50%), patients with alcohol misuse without critical illness (38%; 95% CI 36%, 39%), and patients with alcohol misuse and a critical illness (37%; 95% CI 35%, 40%)
Patients with alcohol misuse who are at moderate to high risk for hospital readmission may benefit from targeted interventions to increase rates of outpatient follow-up after hospital discharge

Summary

Introduction

The spectrum ranging from excessive alcohol use without consequences to the presence of an alcohol use disorder (AUD) is referred to as alcohol misuse [1]. Patients with alcohol misuse have significantly higher rates of hospital readmission within 30 days [13, 14]. Up to 20% of Medicare patients will be readmitted to the hospital within 30 days [15]. Because some of these hospital readmissions are avoidable and add unnecessary cost, there has been an intense effort to reduce rates of hospital readmission. Common post-discharge interventions may include a follow-up telephone call, a discharge hotline, and communication with the outpatient provider [17,18,19]. Identifying groups that are at high risk for not following up with their outpatient providers may identify a group where targeted interventions could improve outcomes

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