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Impact of early primary care follow-up after discharge on hospital readmissions

  • Damien BricardEmail author
  • Zeynep Or
Original Paper
First Online:

Abstract

Reducing repeated hospitalizations of patients with chronic conditions is a policy objective for improving system efficiency. We test the hypothesis that the risk of readmission is associated with the timing and intensity of primary care follow-up after discharge, focusing on patients hospitalized for heart failure in France. We propose a discrete-time model which takes into account that primary care treatments have a lagged and cumulative effect on readmission risk, and an instrumental variable approach, exploiting geographical differences in availability of generalists. We show that the early consultations with a GP after discharge can reduce the 28-day readmission risk by almost 50%, and that patients with higher ambulatory care utilization have smaller odds of readmission. Furthermore, geographical disparities in primary care affect indirectly the readmission risk. These results suggest that interventions which strengthen communication between hospitals and generalists are elemental for reducing readmissions and for developing effective strategies at the hospital level, it is also necessary to consider primary care resources that are available to patients.

Keywords

Readmissions Primary care Hospital Instrumental variable Discrete-time model 

JEL Classification

C22 I12 L24 
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Notes

Acknowledgements

We would like to thank Brigitte Dormont, Anne Penneau, Denis Raynaud, Thérèse Stukel, and Marianne Tenand for their helpful comments and suggestions on a previous version of this paper which allowed improving substantially the content. We are also grateful to Nelly Le Guen who helped to construct the database used in the analysis and Nicola Sirven for his helpful remarks on the estimation strategy. Any remaining errors and omissions are our own.

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare no competing financial interest.

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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institut de Recherche et de Documentation en Economie de la Santé (IRDES)ParisFrance

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