Abstract
Outpatient follow-up after hospital discharge improves continuity of care and reduces readmissions, but rates of follow-up remain low. It is not known whether electronic medical record (EMR)-based tools improve follow-up. The aim of this study was to determine if an EMR-based order to secure cardiology follow-up appointments at hospital discharge would improve follow-up rates and hospital readmission rates. A pre-post interventional study was conducted and evaluated 39,209 cardiovascular medicine discharges within an academic center between 2012 and 2017. Follow-up rates and readmission rates were compared during 2 years prior to EMR-order implementation (pre-order era 2012–2013, n = 12,852) and 4 years after implementation (EMR-order era 2014–2017, n = 26,357). The primary endpoint was 90-day cardiovascular follow-up rates within our health system. In the overall cohort, the mean age of patients was 69.3 years [SD 14.7] and 60.7% (n = 23,827) were male. In the pre-order era, 90-day follow-up was 56.7 ± 0.4% (7286 of 12,852) and increased to 67.9 ± 0.3% (17,888 of 26,357, P < 0.001) in the EMR-order era. The use of the EMR follow-up order was independently associated with increased outpatient follow-up within 90 days after adjusting for patient demographics and payor status (OR 3.28, 95% CI 3.10–3.47, P < 0.001). The 30-day readmission rate in the pre-order era was 12.8% (1642 of 12,852) compared with 13.7% (3601 of 26,357, P = 0.016) in the EMR-order era. An EMR-based appointment order for follow-up appointment scheduling was associated with increased cardiovascular medicine follow-up, but was not associated with an observed reduction in 30-day readmission rates.
Highlights
The period after hospitalization has been well documented as a high-risk period during which patients are vulnerable to adverse health outcomes including readmission and death1
The study population included 39,209 patient discharges of which 12,852 discharges were in the pre-order era (2012–2013) and 26,357 discharges were in the electronic medical record (EMR)-order era (2014–2017)
This study of 39,209 discharges from the cardiovascular service line at a single large hospital demonstrated that the implementation of an EMR-based appointment order led to a substantial and sustained improvement in the rates of 90-day cardiovascular follow-up after hospital discharge
Summary
The period after hospitalization has been well documented as a high-risk period during which patients are vulnerable to adverse health outcomes including readmission and death. One-fifth of Medicare patients are readmitted within 30 days of the index hospitalization. The median 30-day mortality rate after hospital discharge among Medicare patients is 10–15% for stroke, acute myocardial infarction (AMI), heart failure, and pneumonia. The median 30-day mortality rate after hospital discharge among Medicare patients is 10–15% for stroke, acute myocardial infarction (AMI), heart failure, and pneumonia3 During this period, timely follow-up after hospital discharge improves transitions in care, reduces readmissions, and may improve mortality. Multiple studies have demonstrated that patients who have an early follow-up after discharge have a lower risk of 30-day readmission. A recent study showed that 30% of AMI patients who were lost to follow-up had higher mortality rates
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
