Does having an outpatient visit after hospital discharge reduce the likelihood of readmission?
OBJECTIVE
To determine whether or not having an outpatient visit after hospital discharge is associated with a lower likelihood of readmission for a statewide Medicaid population.


METHODS
A case-control study in the Delaware Medicaid program over a two-year period (7/1/93-6/30/95).


METHODS
3,846 continuously enrolled patients aged 0-64 years who were hospitalized and were readmitted within 90 days (cases = 641) or not readmitted within 90 days (controls = 3,205). Subgroups included those readmitted for the same diagnosis (N = 720), for ambulatory care sensitive conditions (N = 906), or both (N = 276).


METHODS
Likelihood of readmission within 90 days of discharge.


RESULTS
Readmission was significantly more likely when an outpatient visit was made after hospital discharge, both before and after controlling for demographic variables and case mix (adjusted odds ratio = 1.47, 95% confidence interval = 1.20-1.80). When readmission for the same diagnosis was examined, having an outpatient visit was associated with an increased likelihood of readmission before but not after controlling for demographics and case mix (adjusted odds ratio = 1.11, 95% confidence interval = 0.67-1.86). The same was for those admitted for ambulatory care sensitive conditions (adjusted odds ratio = 1.16, 95% confidence interval = 0.74-1.85) and for those readmitted for the same ambulatory care sensitive condition (adjusted odds ratio = 1.53, 95% confidence interval = 0.54-4.29).


CONCLUSIONS
This study fails to demonstrate that outpatient visits after hospital discharge are associated with fewer readmissions for nonelderly Medicaid patients. This suggests that it may not be appropriate to use hospital readmission rates as an indicator of the quality of outpatient care.
Gill
James M
JM
Department of Family and Community Medicine, Christiana Care Health System, Newark, Delaware, USA.
Mainous
Arch G
AG
Nsereko
Musa
M
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D003691:Delaware; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016013:Likelihood Functions; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010359:Patient Readmission / Q000639:trends*; D019984:Quality Indicators, Health Care; D014481:United States