Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure.
BACKGROUND
Readmission after hospitalization for heart failure is common. Early outpatient follow-up after hospitalization has been proposed as a means of reducing readmission rates. However, there are limited data describing patterns of follow-up after heart failure hospitalization and its association with readmission rates.


OBJECTIVE
To examine associations between outpatient follow-up within 7 days after discharge from a heart failure hospitalization and readmission within 30 days.


METHODS
Observational analysis of patients 65 years or older with heart failure and discharged to home from hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure and the Get With the Guidelines-Heart Failure quality improvement program from January 1, 2003, through December 31, 2006.


METHODS
All-cause readmission within 30 days after discharge.


RESULTS
The study population included 30,136 patients from 225 hospitals. Median length of stay was 4 days (interquartile range, 2-6) and 21.3% of patients were readmitted within 30 days. At the hospital level, the median percentage of patients who had early follow-up after discharge from the index hospitalization was 38.3% (interquartile range, 32.4%-44.5%). Compared with patients whose index admission was in a hospital in the lowest quartile of early follow-up (30-day readmission rate, 23.3%), the rates of 30-day readmission were 20.5% among patients in the second quartile (risk-adjusted hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.78-0.93), 20.5% among patients in the third quartile (risk-adjusted HR, 0.87; 95% CI, 0.78-0.96), and 20.9% among patients in the fourth quartile (risk-adjusted HR, 0.91; 95% CI, 0.83-1.00).


CONCLUSIONS
Among patients who are hospitalized for heart failure, substantial variation exists in hospital-level rates of early outpatient follow-up after discharge. Patients who are discharged from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission.


BACKGROUND
clinicaltrials.gov Identifier: NCT00344513.
Hernandez
Adrian F
AF
Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA. adrian.hernandez@duke.edu
Greiner
Melissa A
MA
Fonarow
Gregg C
GC
Hammill
Bradley G
BG
Heidenreich
Paul A
PA
Yancy
Clyde W
CW
Peterson
Eric D
ED
Curtis
Lesley H
LH
D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010351:Patient Discharge; D010359:Patient Readmission; D013997:Time Factors; D014481:United States