Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort study

Abstract

BackgroundThe period following hospital discharge is one of significant vulnerability. Little is known about the relationship between post-discharge healthcare use and the risk of readmission. ObjectivesTo explore associations between medical consultations and other healthcare use parameters and the risk of 30-day unplanned hospital readmission. MethodsBetween July 2017 and March 2018, we monitored all adult internal medicine patients for 30 days after their discharge from four mid-sized hospitals. Using follow-up telephone calls, we assessed their post-discharge healthcare use: consultations with general practitioners (GPs) and specialist physicians, emergency room (ER) visits, and home visits by nurses. The binary outcome was defined as any unplanned hospital readmission within 30 days of discharge, and this was analyzed using logistic regression. ResultsOf 934 patients discharged, 111 (12%) experienced at least one unplanned hospital readmission within 30 days. Attending at least one GP consultation decreased the odds of readmission by half (adjusted OR: 0.5; 95%CI: 0.3–0.7), whereas attending at least one specialist consultation doubled those odds (aOR: 2.0; 95%CI: 1.2–3.3). GP consultations also reduced the odds of the combined risk of an ER visit or unplanned hospital readmission (aOR: 0.5; 95%CI: 0.3–0.7). ER visits were also associated with a higher readmission risk after adjusting for confounding factors (aOR: 10.0; 95%CI: 6.0–16.8). ConclusionGP consultations were associated with fewer ER visits and unplanned hospital readmissions.