A comparison of hospital readmission rates between two general physicians with different outpatient review practices.
BACKGROUND
There has been a relentless increase in emergency medical admissions in the UK over recent years. Many of these patients suffer with chronic conditions requiring continuing medical attention. We wished to determine whether conventional outpatient clinic follow up after discharge has any impact on the rate of readmission to hospital.


METHODS
Two consultant general physicians with the same patient case-mix but markedly different outpatient follow-up practice were chosen. Of 1203 patients discharged, one consultant saw twice as many patients in the follow-up clinic than the other (Dr A 9.8% v Dr B 19.6%). The readmission rate in the twelve months following discharge was compared in a retrospective analysis of hospital activity data. Due to the specialisation of the admitting system, patients mainly had cardiovascular or cerebrovascular disease or had taken an overdose. Few had respiratory or infectious diseases. Outpatient follow-up was focussed on patients with cardiac disease.


RESULTS
Risk of readmission increased significantly with age and length of stay of the original episode and was less for digestive system and musculo-skeletal disorders. 28.7% of patients discharged by Dr A and 31.5 % of those discharged by Dr B were readmitted at least once. Relative readmission risk was not significantly different between the consultants and there was no difference in the length of stay of readmissions.


CONCLUSIONS
Increasing the proportion of patients with this age- and case-mix who are followed up in a hospital general medical outpatient clinic is unlikely to reduce the demand for acute hospital beds.
Rayner
Hugh C
HC
Birmingham Heartlands and Solihull NHS Trust (Teaching), Birmingham, UK. Raynerh@heartsol.wmids.nhs.uk
Temple
R Mark
RM
Marshall
Tim
T
Clarke
Dianne
D
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003953:Diagnosis-Related Groups; D017050:Episode of Care; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay / Q000706:statistics & numerical data; D008485:Medical Audit; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014600:Utilization Review