title: Post-discharge follow-up visits and hospital utilization by Medicare patients, 2007-2010.
abstract: OBJECTIVE
  Document trends in time to post-discharge follow-up visit for Medicare patients with an index admission for heart failure (HF), acute myocardial infarction (AMI), or community-acquired pneumonia (CAP). Determine factors predicting whether the first post-discharge utilization event is a follow-up visit, treat-and-release emergency department (ED) visit, or readmission.
  
  
  METHODS
  Using Medicare claims data from 2007-2010, we plotted annual cumulative incidence functions for the time frame post-discharge to follow-up visit, accounting for competing risks with censoring at 30 days. We used multinomial probit regression to determine factors predicting the probability of first-occurring post-discharge utilization events within 30 days.
  
  
  RESULTS
  For each cohort, the cumulative incidence of follow-up visits increased during the study period. For example, in 2010, 54.6% of HF patients had a follow-up visit within 10 days of discharge compared to 47.9% in 2007. Within each cohort, the largest increase in follow-up visits took place between 2008 and 2009. Follow-up visits were less likely for patients who were Black, Hispanic, and enrolled in Medicaid or Medicare Advantage, and they were more likely for patients with greater comorbidities and prior procedures as well as those with private or supplemental Medicare coverage. There were no changes in 30-day readmission rates.
  
  
  CONCLUSIONS
  Although increases in follow-up visits may have been influenced by the introduction of publicly reported readmission rates in 2009, these increases did not continue in 2010 and were not associated with a change in readmissions. Patients who were Black, Hispanic, and/or enrolled in Medicaid or Medicare Advantage were less likely to have follow-up visits.
authors.affiliation: Rutgers University-Center for State Health Policy.
authors.forename: Derek
authors.initials: D
authors.lastname: DeLia
authors.affiliation: Rutgers University-Center for State Health Policy.
authors.forename: Jian
authors.initials: J
authors.lastname: Tong
authors.affiliation: Rutgers University-Center for State Health Policy.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Gaboda
authors.affiliation: Weill Cornell Medical College-Division of Outcomes and Effectiveness.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Medicare; biostatistical methods; econometrics; health policy; law; politics; primary care; quality improvement; regulation; report cards (interventions)