Effect of a hospitalist-run postdischarge clinic on outcomes.
J Hosp Med. 2014 Jan;9(1):7-12
Authors: Burke RE, Whitfield E, Prochazka AV
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).
DESIGN: Retrospective cohort study using propensity scoring in multivariate analysis.
PATIENTS: Consecutive Veterans discharged home after a nonscheduled admission seen in PDC, UC, or PCP within 30 days of discharge.
INTERVENTIONS: 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.
MAIN MEASURES: The primary outcome was a composite of hospital readmissions, Emergency Department visits, and mortality 30 days after discharge.
KEY 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. Journal of Hospital Medicine 2014;9:7-12. © 2013 Society of Hospital Medicine.
PMID: 24390821 [PubMed - in process]