title: General practitioners' home visit tendency and readmission-free survival after COPD hospitalisation: a Danish nationwide cohort study.
abstract: BACKGROUND
  The tendency of general practitioners (GPs) to conduct home visits is considered an important aspect of practices' accessibility and quality of care.
  
  
  OBJECTIVE
  To investigate whether GPs' tendency to conduct home visits affects 30-day readmission or death after hospitalisation with chronic obstructive pulmonary disease.
  
  
  METHODS
  All Danish patients first-time hospitalised with COPD during the years 2006-2008 were identified. The association between the GP's tendency to conduct home visits and the time from hospital discharge until death or all-cause readmission was analysed by means of Cox regression adjusted for multiple patient and practice characteristics.
  
  
  RESULTS
  The study included 14,425 patients listed with 1,389 general practices. Approximately 31% of the patients received a home visit during the year preceding their first COPD hospitalisation, and within 30 days after discharge 19% had been readmitted and 1.6% had died without readmission. A U-shaped dose-response relationship was found between GP home visit tendency and readmission-free survival. The lowest adjusted risk of readmission or death was recorded among patients who were listed with a general practice in which >20-30% of other listed first-time COPD-hospitalised patients had received a home visit. The risk was higher if either 0% (hazard rate ratio 1.18 (1.01-1.37)) or >60% (hazard rate ratio 1.23 (1.04-1.44)) of the patients had been visited.
  
  
  CONCLUSIONS
  A moderate GP tendency to conduct home visits is associated with the lowest 30-day risk of COPD readmission or death. A GP's tendency to conduct home visits should not be used as a unidirectional indicator of the ability to prevent COPD hospital readmissions.
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Lykkegaard
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Pia V
authors.initials: PV
authors.lastname: Larsen
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Maja S
authors.initials: MS
authors.lastname: Paulsen
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Søndergaard
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D058006:General Practice; D006792:House Calls / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate