title: Patterns of community follow-up, subsequent health service use and survival among young and mid-life adults discharged from chronic care hospitals: a retrospective cohort study.
abstract: Despite the demand for rehabilitation and chronic care services across the life course, policy and care strategies tend to focus on older adults and overlook medically complex younger adult populations. This study examined young and mid-life adults discharged from tertiary chronic care hospitals in order to describe their health service use and to examine the association between patterns of timely community follow-up, and subsequent health outcomes.
  
  
  
  This population-based retrospective cohort study used linked administrative data to identify 1,906 individuals aged 18-64 years and discharged alive from tertiary chronic care hospitals in Ontario, Canada between April 1, 2005 and March 31, 2006. Multivariate Cox proportional hazard models were used to examine the effect of community follow-up within 7 days of discharge (home care and/or a primary care physician visit or neither) on time to first hospitalization and emergency department (ED) visit. Five-year survival was examined using Kaplan-Meier survival curves.
  
  
  
  The cohort had a high prevalence of multi-morbidity and use of hospital, emergency services and physician services was high in the year following discharge. Most individuals received follow-up care from a primary care physician and/or home care within 7 days of discharge while 30 % received neither. Within 1 year of discharge, 18 % of individuals died. Among those who survived, time to acute care hospitalization in the year following discharge was significantly longer among those who received both a home care and a physician follow-up visit compared to those who received neither. No significant associations were found between community follow-up and ED visits within 1 year.
  
  
  
  Immediate community follow-up may reduce subsequent use of acute care services. Future research should determine why some individuals, who would likely benefit from services, are not receiving them including barriers to access.
authors: Lunenfeld-Tanenbaum Research Institute, Sinai Health System (Bridgepoint Hospital Site), 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada. KKuluski@Bridgepointhealth.ca.|Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3 M6, Canada. KKuluski@Bridgepointhealth.ca.
authors: Kerry
authors: K
authors: Kuluski
authors: Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada.
authors: Sima
authors: S
authors: Gandhi
authors: Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada.
authors: Christina
authors: C
authors: Diong
authors: Lunenfeld-Tanenbaum Research Institute, Sinai Health System (Bridgepoint Hospital Site), 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada.|Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3 M6, Canada.
authors: Carolyn
authors: C
authors: Steele Gray
authors: Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3 M6, Canada.|Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada.
authors: Susan E
authors: SE
authors: Bronskill
mesh_terms: D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000401:mortality / Q000628:therapy*; D003153:Community Health Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D055815:Young Adult