BACKGROUND: Patients are often treated in hospital by physicians other than their regular community doctor. After they are discharged, their care is often returned to their regular community doctor and patients may not see the hospital physician. Transfer of information between physicians can be poor. We determined whether early postdischarge outcomes changed when patients were seen after discharge by physicians who treated them in the hospital.
METHODS: This cohort study used population-based administrative databases to follow 938,833 adults from Ontario, Canada, after they were discharged alive from a nonelective medical or surgical hospitalization between April 1, 1995, and March 1, 2000. We determined when patients were seen after discharge by physicians who treated them in the hospital, physicians who treated them 3 months prior to admission (community physicians), and specialists. The outcome of interest was 30-day death or nonelective readmission to hospital.
RESULTS: Of patients studied, 7.7% died or were readmitted. The adjusted relative risk of death or readmission decreased by 5% (95% confidence interval [CI], 4% to 5%) and 3% (95% CI, 2% to 3%) with each additional visit to a hospital physician rather than a community physician or specialist, respectively. The effect of hospital physician visits was cumulative, with the adjusted risk of 30-day death or nonelective readmission reduced to 7.3%, 7.0%, and 6.7% if patients had 1, 2, or 3 visits, respectively, with a hospital rather than a community physician. The effect was consistent across important subgroups.
CONCLUSIONS: Patient outcomes could be improved if their early postdischarge visits were with physicians who treated them in hospital rather than with other physicians. Follow-up visits with a hospital physician, rather than another physician, could be a modifiable factor to improve patient outcomes following discharge from hospital.
continuity of care hospital readmission population-based administrative databases
This is a preview of subscription content, log in to check access.
Soeken KL, Prescott PA, Herron DG, Creasia J. Predictors of hospital readmission. A meta-analysis. Eval Health Prof. 1991;14:262–81.PubMedCrossRefGoogle Scholar
Boult C, Dowd B, McCaffrey D, Boult L, Hernandez R, Krulewitch H. Screening elders for risk of hospital admission. J Am Geriatr Soc. 1993;41:811–7.PubMedGoogle Scholar
Anderson GF, Steinberg EP. Predicting hospital readmissions in the Medicare population. Inquiry. 1985;22:251–8.PubMedGoogle Scholar
Krumholz HM, Parent EM, Tu N, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 1997;157:99–104.PubMedCrossRefGoogle Scholar
Chin MH, Goldman L. Correlates of early hospital readmission or death in patients with congestive heart failure. Am J Cardiol. 1997;79:1640–4.PubMedCrossRefGoogle Scholar
Hennen J, Krumholz HM, Radford MJ, Meehan TP. Readmission rates, 30 days and 365 days postdischarge, among the 20 most frequent DRG groups, Medicare inpatients age 65 or older in Connecticut hospitals, fiscal years 1991, 1992, and 1993. Conn Med. 1995;59:263–70.PubMedGoogle Scholar
Holloway JJ, Medendorp SV, Bromberg J. Risk factors for early readmission among veterans. Health Serv Res. 1990;25(1 pt 2):213–37.PubMedGoogle Scholar
Phillips RS, Safran C, Cleary PD, Delbanco TL. Predicting emergency readmissions for patients discharged from the medical service of a teaching hospital. J Gen Intern Med. 1987;2:400–5.PubMedCrossRefGoogle Scholar
Stanton BA, Jenkins CD, Goldstein RL, et al. Hospital readmissions among survivors six months after myocardial revascularization. JAMA. 1985;253:3568–73.PubMedCrossRefGoogle Scholar
Weissman JS, Stern RS, Epstein AM. The impact of patient socioeconomic status and other social factors on readmission: a prospective study in four Massachusetts hospitals. Inquiry. 1994;31:163–72.PubMedGoogle Scholar
van Walraven C, Bell CM. Risk of dealth or readmission among people discharged from hospital on Fridays. CMAJ. 2002;166:1672–3.PubMedGoogle Scholar
Reed RL, Pearlman RA, Buchner DM. Risk factors for early unplanned hospital readmission in the elderly. J Gen Intern Med. 1991;6:223–8.PubMedCrossRefGoogle Scholar
Corrigan JM, Martin JB. Identification of factors associated with hospital readmission and development of a predictive model. Health Serv Res. 1992;27:81–101.PubMedGoogle Scholar
Colledge NR, Ford MJ. The early hospital readmission of elderly people. Scott Med J. 1994;39:51–2.PubMedGoogle Scholar
van Walraven C, Seth R, Austin PC, Laupacis A. The effect of discharge summary availability during post-discharge outpatient visits on readmission to hospital. J Gen Intern Med. 2002;17:1–8.CrossRefGoogle Scholar
Bolton P, Mira M, Kennedy P, Lahra MM. The quality of communication between hospitals and general practitioners: an assessment. J Qual Clin Pract. 1998;18:241–7.PubMedCrossRefGoogle Scholar
Fair JF. Hospital discharge and death communications. Br J Hosp Med. 1989;42:59–61.PubMedGoogle Scholar
Lockwood E, McCallum FM. Patients discharged from hospital: an aspect of communication in the Health Service. Health Bull. 1970;28:75–80.Google Scholar
van Walraven C, Weinberg AL. Quality assessment of a discharge summary system. Can Med Assoc J. 1995;152:1437–42.Google Scholar
Mageean RJ. Study of “discharge communications” from hospital. Br Med J (Clin Res Ed). 1986;293:1283–4.Google Scholar
Harding J. Study of discharge communications from hospital doctors to an inner London general practice. J R Coll Gen Pract. 1987;37:494–5.PubMedGoogle Scholar
Penney TM. Delayed communication between hospitals and general practitioners: where does the problem lie? Br Med J. 1988;297:28–9.CrossRefGoogle Scholar
Weinberger M, Oddone EZ, Henderson WG. Does increased access to primary care reduce hospital readmissions? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission. N Engl J Med. 1996;334:1441–7.PubMedCrossRefGoogle Scholar
Magill MK, Babitz M, Silver MP. A trial of increased access to primary care. N Engl J Med. 1996;335:896–8.PubMedGoogle Scholar