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General practitioners' home visit tendency and readmission-free survival after COPD hospitalisation: a Danish nationwide cohort study.
NPJ Prim Care Respir Med. 2014;24:14100
Authors: Lykkegaard J, Larsen PV, Paulsen MS, Søndergaard J
Abstract
BACKGROUND: The tendency of general practitioners (GPs) to conduct home visits is considered an important aspect of practices' accessibility and quality of care.
AIMS: 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.
CONCLUSION: 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.
PMID: 25429436 [PubMed - indexed for MEDLINE]