title: Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults.
abstract: BACKGROUND
  Rehospitalizations within 30 days of discharge are responsible for a large portion of healthcare spending. One approach to preventing rehospitalizations is early follow-up, usually defined as an office visit with a primary care physician within 7 days of discharge--an approach that is being incentivized by health plans. However, evidence regarding its effectiveness is limited.
  
  
  OBJECTIVE
  We aimed to determine whether an office visit with a primary care physician within 7 days after discharge is associated with 30-day rehospitalization.
  
  
  METHODS
  This was an observational study set within a randomized trial.
  
  
  METHODS
  The study included patients age 65 and older receiving care from a multi-specialty group practice and discharged from hospital to home between 26 August 2010 and 25 August 2011. To control for confounding, we identified characteristics of patients and hospital stays that are predictive of rehospitalization, and also developed high-dimensional propensity scores. Analyses used Cox proportional hazards models and took into account varying amounts of opportunity time for office visits.
  
  
  METHODS
  We looked at 30-day rehospitalizations at any hospital.
  
  
  RESULTS
  Of 3,661 patients discharged to home during the study year, 707 (19.3%) were rehospitalized within 30 days. Patients receiving an office visit within 7 days numbered 1,808 (49.4%), and of these, 1,000 (27.3%) were with a primary care physician. In models predicting rehospitalization, stratified on deciles of propensity score and controlling for additional confounders, the hazard ratios associated with office visits with a primary care physician within 7 days were 0.98 (95% CI 0.80, 1.21); for visits with any physician, the hazard ratio was HR 1.04, (95% CI 0.87, 1.25).
  
  
  CONCLUSIONS
  We found no protective effect for office visits within 7 days. Such visits may need to be specifically focused on a range of issues related to the specific reasons why patients are rehospitalized. It is likely that outpatient visits will need to be set within comprehensive transition programs.
authors.affiliation: Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, 630 Plantation Street, Worcester, MA, 01605, USA, terry.field@umassmed.edu.
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Jessica
authors.initials: J
authors.lastname: Ogarek
authors.forename: Lawrence
authors.initials: L
authors.lastname: Garber
authors.forename: George
authors.initials: G
authors.lastname: Reed
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000639:trends; D015577:Geriatric Assessment; D015994:Incidence; D007902:Length of Stay; D015999:Multivariate Analysis; D009819:Office Visits / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D061214:Patient Safety; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D057216:Propensity Score; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013997:Time Factors; D014481:United States; D016032:Randomized Controlled Trials as Topic