Abstract
Background
Timely primary care follow-up after acute care discharge may improve outcomes.
Objective
To evaluate whether post-discharge follow-up rates differ among patients discharged from hospitals directly affiliated with their primary care clinic (same-site), other hospitals within their health system (same-system), and hospitals outside their health system (outside-system).
Design
Retrospective cohort study.
Patients
Adult patients of five primary care clinics within a 14-hospital health system who were discharged home after a hospitalization or emergency department (ED) stay.
Main Measures
Primary care visit within 14 days of discharge. A multivariable Poisson regression model was used to estimate adjusted rate ratios (aRRs) and risk differences (aRDs), controlling for sociodemographics, acute visit characteristics, and clinic characteristics.
Key Results
The study included 14,310 discharges (mean age 58.4 [SD 19.0], 59.5% female, 59.5% White, 30.3% Black), of which 57.7% were from the same-site, 14.3% same-system, and 27.9% outside-system. By 14 days, 34.5% of patients discharged from the same-site hospital received primary care follow-up compared to 27.7% of same-system discharges (aRR 0.88, 95% CI 0.79 to 0.98; aRD − 6.5 percentage points (pp), 95% CI − 11.6 to − 1.5) and 20.9% of outside-system discharges (aRR 0.77, 95% CI [0.70 to 0.85]; aRD − 11.9 pp, 95% CI − 16.2 to − 7.7). Differences were greater for hospital discharges than ED discharges (e.g., aRD between same-site and outside-system − 13.5 pp [95% CI, − 20.8 to − 8.3] for hospital discharges and − 10.1 pp [95% CI, − 15.2 to − 5.0] for ED discharges).
Conclusions
Patients discharged from a hospital closely affiliated with their primary care clinic were more likely to receive timely follow-up than those discharged from other hospitals within and outside their health system. Improving care transitions requires coordination across both care settings and health systems.
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Data Availability
Individual-level data sharing is not available given study based on electronic health records.
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Funding
Dr. Anderson was supported by career development awards from the National Institute on Aging (K76AG074878) and American Heart Association. The American Heart Association and the National Institute on Aging had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Dr. Anderson had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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Dr. Anderson reports grants from the American Heart Association outside of the submitted work. Dr. Herzig reports grants from the Agency for Healthcare Research and Quality outside of the submitted work. Dr. Landon reports grants from the Agency for Healthcare Research and Quality and National Institute on Aging outside of the submitted work.
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The research reported in this publication was supported by the American Heart Association and the National Institute on Aging of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Heart Association or the National Institutes of Health.
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Anderson, T.S., O’Donoghue, A.L., Herzig, S.J. et al. Differences in Primary Care Follow-up After Acute Care Discharge Within and Across Health Systems: a Retrospective Cohort Study. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08610-3
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DOI: https://doi.org/10.1007/s11606-024-08610-3