Abstract
BackgroundThirty-day readmission rates after acute myocardial infarction (AMI) and heart failure are important patient outcome metrics. Early post-discharge physician follow-up has been promoted as a method of reducing 30-day readmission rates. However, the relationships between early post-discharge follow-up and 30-day readmission for AMI and heart failure are inconclusive. We used nationwide population-based data to examine associations between 7-day physician follow-up and 30-day readmission, and further associations of 7-day same physician (during the index hospitalization and at follow-up) and cardiologist follow-up with 30-day readmission for non-ST-segment-elevation myocardial infarction (NSTEMI) or heart failure.MethodsWe analyzed all patients 18 years or older with NSTEMI and heart failure and discharged from hospitals in 2010 in Taiwan through Taiwan’s National Health Insurance Research Database. Cox proportional hazard models with robust sandwich variance estimates and propensity score weighting were performed after adjustment for patient and hospital characteristics to test associations between 7-day physician follow-up and 30-day readmission.ResultsThe study population for NSTEMI and heart failure included 5,008 and 13,577 patients, respectively. Early physician follow-up was associated with a lower hazard ratio of readmission compared with no early physician follow-up for patients with NSTEMI (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.39–0.57), and for patients with heart failure (HR, 0.54; 95% CI, 0.48–0.60). Same physician follow-up was associated with a reduced hazard ratio of readmission compared with different physician follow-up for patients with NSTEMI (HR, 0.56; 95% CI, 0.48–0.65), and for patients with heart failure (HR, 0.69; 95% CI, 0.62–0.76).ConclusionsFor each condition, patients who have an outpatient visit with a physician within 7 days of discharge have a lower risk of 30-day readmission. Moreover, patients who have an outpatient visit with the same physician within 7 days of discharge have a much lower risk of 30-day readmission.
Highlights
Policy makers, clinicians, and payers who seek to improve outcomes in health care are focusing on 30-day readmission rates for patients with acute myocardial infarction and those with heart failure.[1]
Physician follow-up was associated with a lower hazard ratio of readmission compared with no early physician follow-up for patients with non-ST-segment-elevation myocardial infarction (NSTEMI), and for patients with heart failure (HR, 0.54; 95% CI, 0.48–0.60)
Patients who have an outpatient visit with a physician within 7 days of discharge have a lower risk of 30-day readmission
Summary
Clinicians, and payers who seek to improve outcomes in health care are focusing on 30-day readmission rates for patients with acute myocardial infarction and those with heart failure.[1] Early post-discharge physician follow-up has been promoted as a method of reducing readmission rates.[2] studies on the relationships between early post-discharge follow-up and patient outcomes for acute myocardial infarction and heart failure are rare and inconclusive. Of only two studies we are aware of on this topic, one showed that discharge from hospitals that have higher early follow-up rates is associated with a reduction in 30-day readmission for heart failure,[3] but another did not establish such relationship for acute myocardial infarction.[4] to our knowledge, no study has examined whether early follow-up with the same physician or with a cardiologist is associated with lower 30-day readmission for patients with acute myocardial infarction and those with heart failure. The immediate days that follow discharge are a vulnerable period owing to the additional therapies or changes in existing medical therapy that may worsen patient outcomes. [3, 11] Seven-day follow-up with the physicians may have the benefit of improving patient outcomes through providing clinical interventions on disease instability (such as diagnostic testing and medication changes),[12] and 7-day follow-up with the same physician (because of physician continuity) or with a specialist (because of physician specialty) may be associated with better outcomes than follow-up with other physicians.[3, 4] few studies have examined the relationship between 7-day physician follow-up and patient outcomes
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