title: Effect of a hospitalist-run postdischarge clinic on outcomes.
abstract: BACKGROUND
  New post-discharge strategies to reduce adverse events are needed.
  
  
  OBJECTIVE
  To determine whether follow-up in a hospitalist-run post-discharge clinic (PDC) decreases post-discharge adverse events when compared to follow-up in a primary care clinic (PCP) or urgent care clinic (UC).
  
  
  METHODS
  Retrospective cohort study using propensity scoring in multivariate analysis.
  
  
  METHODS
  Consecutive Veterans discharged home after a nonscheduled admission seen in PDC, UC, or PCP within 30 days of discharge.
  
  
  METHODS
  Recently discharged patients are seen by housestaff who cared for them during the index admission and staffed with a rotating hospitalist in PDC; UC and PCP patients are seen by housestaff or attending ambulatory physicians.
  
  
  METHODS
  The primary outcome was a composite of hospital readmissions, Emergency Department visits, and mortality 30 days after discharge.
  
  
  RESULTS
  5085 patients met criteria; 538 followed up in PDC (10.6%), 1848 with their PCP (36.3%), and 2699 in UC (53.1%). Patients following up in PDC were older and had a higher comorbidity burden. ICU exposure was similar between groups. Patients seen in PDC had shorter length of stay (LOS) (PDC, 3.8 days, UC, 5.0 days, PCP, 6.2 days; p = 0.04) and time to first post-discharge visit (PDC, 5.0 days, UC, 9.4 days, PCP, 13.7 days; p < 0.01). There were no differences between groups in the primary outcome in unadjusted or propensity-adjusted multivariate analysis.
  
  
  CONCLUSIONS
  Patients seen in a hospitalist-run PDC had similar 30-day post-discharge adverse outcome rates despite a 2.4-day shorter LOS compared to patients seen by their PCP. Prospective testing of PDCs is warranted.
authors.affiliation: Hospital Medicine Section, Department of Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, Colorado; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Burke
authors.forename: Emily
authors.initials: E
authors.lastname: Whitfield
authors.forename: Allan V
authors.initials: AV
authors.lastname: Prochazka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000592:standards / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D020445:Hospitalists / Q000592:standards / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards / Q000639:trends*; D010359:Patient Readmission / Q000592:standards / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome