High-Risk Patients Benefit Significantly From Early Follow-up Post Hospital Discharge

While most patients do not benefit from early follow-up after they are discharged from the hospital, researchers from Duke University Medical Center and Community Care of North Carolina found follow-up within 7 days was associated with substantially lower readmission rates among patients with high clinical complexity and high risk of readmission.

The study used North Carolina Medicaid claims data for hospital-discharged patients from April 2012 to March 2013. From that data, the researchers stratified the patients into 7 risk levels and determined each group’s expected readmission rate.

They found that benefits of early outpatient follow-up varies based on clinical complexity and underlying risk of readmission. The results are published in the Annals of Family Medicine.

“Earlier outpatient follow-up was associated with statistically significant survival from readmission within every risk stratum by 14 days after discharge,” the authors wrote. “The magnitude of the effect of earlier follow-up, however, was far more pronounced in higher risk strata.”

Patients with multiple chronic conditions in the 3 highest risk stata who had follow-up within 14 days had readmission survival rates that were 12-19.1 percentage points higher. Patients with no chronic conditions had a 1.5 percentage point higher readmission survival rate.

However, high-risk patients received 14-day follow-ups at a rate similar to low-risk patients (51% vs 50%, respectively).

“In current practice, one-size-fits-all discharge protocols may be determining a follow-up time frame more than evidence-based decision making or clinical need,” the authors wrote. “Changing reimbursement policies are likely to further influence transitional care processes.”

Based on their findings, the researchers determined that for patients with a readmission risk exceeding 20%, 1 readmission may be prevented for every 5 patients who receive a follow-up within 14 days after discharge. Patients that fall into this category have 3 or more chronic conditions, such as chronic obstructive pulmonary disease, congestive heart failure, diabetes, or a history of organ transplant or dialysis.

“As providers increasingly enter into accountable care arrangements or bundled payment structures for the period after hospital discharge, incentives will be greater for intelligently targeted resource allocation to optimize benefit across the population.”