Patterns of community follow-up, subsequent health service use and survival among young and mid-life adults discharged from chronic care hospitals: a retrospective cohort study.

Kerry Kuluski,Christina Diong,Susan E Bronskill,Carolyn Steele Gray,Sima Gandhi

doi:10.1186/s12913-016-1631-z

Abstract

BackgroundDespite the demand for rehabilitation and chronic care services across the life course, policy and care strategies tend to focus on older adults and overlook medically complex younger adult populations. This study examined young and mid-life adults discharged from tertiary chronic care hospitals in order to describe their health service use and to examine the association between patterns of timely community follow-up, and subsequent health outcomes.MethodsThis population-based retrospective cohort study used linked administrative data to identify 1,906 individuals aged 18–64 years and discharged alive from tertiary chronic care hospitals in Ontario, Canada between April 1, 2005 and March 31, 2006. Multivariate Cox proportional hazard models were used to examine the effect of community follow-up within 7 days of discharge (home care and/or a primary care physician visit or neither) on time to first hospitalization and emergency department (ED) visit. Five-year survival was examined using Kaplan-Meier survival curves.ResultsThe cohort had a high prevalence of multi-morbidity and use of hospital, emergency services and physician services was high in the year following discharge. Most individuals received follow-up care from a primary care physician and/or home care within 7 days of discharge while 30 % received neither. Within 1 year of discharge, 18 % of individuals died. Among those who survived, time to acute care hospitalization in the year following discharge was significantly longer among those who received both a home care and a physician follow-up visit compared to those who received neither. No significant associations were found between community follow-up and ED visits within 1 year.ConclusionsImmediate community follow-up may reduce subsequent use of acute care services. Future research should determine why some individuals, who would likely benefit from services, are not receiving them including barriers to access.

Highlights

Despite the demand for rehabilitation and chronic care services across the life course, policy and care strategies tend to focus on older adults and overlook medically complex younger adult populations
This study focused on a young and mid-life adult population with complex care needs discharged from high intensity tertiary chronic care
Our study shows that young and mid-life adults who are discharged from tertiary chronic care appear to have ongoing impairments, mortality risk and high health system use

Summary

Introduction

Despite the demand for rehabilitation and chronic care services across the life course, policy and care strategies tend to focus on older adults and overlook medically complex younger adult populations. Despite the prevalence of chronic disease across the life course, policy and care strategies tend to focus on older adults; typically 65 years and over. Integrated models of community based care as well as strategies to improve care transitions from hospital to home have typically been developed for older adults with specific diagnoses such as heart failure [4] or COPD [5] with some attention to older adults with multimorbidity [6, 7]. While there tends to be no dominant disease clusters within populations of people with multimorbidity [9] a recent study showed a clustering of specific physical and mental health conditions in the under 65 population [10]

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