Research Article: Relationship between Early Physician Follow-Up and 30-Day Readmission after Acute Myocardial Infarction and Heart Failure

Date Published: January 27, 2017

Publisher: Public Library of Science

Author(s): Yu-Chi Tung, Guann-Ming Chang, Hsien-Yen Chang, Tsung-Hsien Yu, Giuseppe Andò.

http://doi.org/10.1371/journal.pone.0170061

Abstract

Thirty-day readmission rates after acute myocardial infarction (AMI) and heart failure are important patient outcome metrics. Early post-discharge physician follow-up has been promoted as a method of reducing 30-day readmission rates. However, the relationships between early post-discharge follow-up and 30-day readmission for AMI and heart failure are inconclusive. We used nationwide population-based data to examine associations between 7-day physician follow-up and 30-day readmission, and further associations of 7-day same physician (during the index hospitalization and at follow-up) and cardiologist follow-up with 30-day readmission for non-ST-segment-elevation myocardial infarction (NSTEMI) or heart failure.

We analyzed all patients 18 years or older with NSTEMI and heart failure and discharged from hospitals in 2010 in Taiwan through Taiwan’s National Health Insurance Research Database. Cox proportional hazard models with robust sandwich variance estimates and propensity score weighting were performed after adjustment for patient and hospital characteristics to test associations between 7-day physician follow-up and 30-day readmission.

The study population for NSTEMI and heart failure included 5,008 and 13,577 patients, respectively. Early physician follow-up was associated with a lower hazard ratio of readmission compared with no early physician follow-up for patients with NSTEMI (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.39–0.57), and for patients with heart failure (HR, 0.54; 95% CI, 0.48–0.60). Same physician follow-up was associated with a reduced hazard ratio of readmission compared with different physician follow-up for patients with NSTEMI (HR, 0.56; 95% CI, 0.48–0.65), and for patients with heart failure (HR, 0.69; 95% CI, 0.62–0.76).

For each condition, patients who have an outpatient visit with a physician within 7 days of discharge have a lower risk of 30-day readmission. Moreover, patients who have an outpatient visit with the same physician within 7 days of discharge have a much lower risk of 30-day readmission.

Partial Text

Policy makers, clinicians, and payers who seek to improve outcomes in health care are focusing on 30-day readmission rates for patients with acute myocardial infarction and those with heart failure.[1] Early post-discharge physician follow-up has been promoted as a method of reducing readmission rates.[2] However, studies on the relationships between early post-discharge follow-up and patient outcomes for acute myocardial infarction and heart failure are not only rare but also inconclusive. Of only two studies we are aware of on this topic, one showed that discharge from hospitals that have higher early follow-up rates is associated with a reduction in 30-day readmission for heart failure,[3] but another did not establish such relationship for acute myocardial infarction.[4] Moreover, to our knowledge, no study has examined whether early follow-up with the same physician or with a cardiologist is associated with lower 30-day readmission for patients with acute myocardial infarction and those with heart failure.

This study was the first research using nationwide population-based data to examine the association between early physician follow-up and 30-day readmission, and the relative association of early same physician and early cardiologist follow-up with 30-day readmission for NSTEMI and heart failure. For each condition, we found that early physician follow-up was associated with decreased 30-day readmission compared with no early physician follow-up. Moreover, early follow-up with the same physician was associated with lower 30-day readmission compared with early follow-up with a different physician.

Our national population-based study showed that 7-day physician follow-up was associated with lower 30-day readmission, and physician continuity (7-day same physician follow-up) was associated with much lower 30-day readmission for patients with NSTEMI and those with heart failure. This study may provide evidence in support of guidelines recommending scheduling an early follow-up visit after discharge, and it may provide an evidenced-based approach to improve 30-day readmission following NSTEMI and heart failure.

 

Source:

http://doi.org/10.1371/journal.pone.0170061

 

0 0 vote
Article Rating
Subscribe
Notify of
guest
0 Comments
Inline Feedbacks
View all comments