title: The characteristics and impact of a hospitalist-staffed post-discharge clinic.
abstract: BACKGROUND
  Limited primary care access and care discontinuities hamper care for patients following hospital discharge. As the proportion of inpatient care delivered by hospitalists continues to increase, hybrid models that incorporate hospitalists in post-discharge care may ameliorate this problem.
  
  
  METHODS
  We established a post-discharge clinic staffed by hospitalists in a large academic urban primary care practice in October 2009. We compared visits of recently hospitalized patients seen in the post-discharge clinic with post-discharge visits elsewhere in the practice, including patient demographics, health care utilization, and duration from discharge, using generalized estimating equations to account for repeated hospitalizations.
  
  
  RESULTS
  Patients seen in the post-discharge clinic and elsewhere in the practice were generally similar, although patients seen in the post-discharge clinic were particularly likely to be black and receive primary care from residents. Relative to other patients seen following discharge, patients in the post-discharge clinic were seen 8.45 ± 0.43 days earlier (P <.001). Among all 10,845 discharges of Healthcare Associates patients between 2009 and 2011, patients were 40% more likely to be seen within a week of discharge when the post-discharge clinic was open than when it was closed (adjusted odds ratio 1.41; 95% confidence interval, 1.25-1.57).
  
  
  CONCLUSIONS
  In this primary care practice, a hospitalist-staffed post-discharge clinic was associated with substantially shorter time to first post-hospitalization visit and with improvement in the overall likelihood of an early visit among all hospitalized patients. It was particularly used by black patients and those seen by residents, in whom access tends to be most fragmented, and may represent a novel approach to the problem of post-discharge care.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass. Electronic address: ldoctoro@bidmc.harvard.edu.
authors.forename: Lauren
authors.initials: L
authors.lastname: Doctoroff
authors.forename: Ank
authors.initials: A
authors.lastname: Nijhawan
authors.forename: Diane
authors.initials: D
authors.lastname: McNally
authors.forename: Anita
authors.initials: A
authors.lastname: Vanka
authors.forename: Roger
authors.initials: R
authors.lastname: Yu
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data; D020445:Hospitalists / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D010351:Patient Discharge; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D013997:Time Factors; D000078329:Workforce
keywords: Hospitalist; Post-discharge; Transitions of care