Carlos T. Jackson|Mohammad Shahsahebi|Tiffany Wedlake|C. Annette DuBard
Timeliness of Outpatient Follow-up: An Evidence-Based Approach for Planning After Hospital Discharge
Community Care|Duke Medical Center|Community Care|Community Care
timely outpatient followup promoted key strategy reduce hospital readmissions though onehalf patients readmitted within 30 days hospital discharge followup readmission guidance needed identify optimal timing hospital followup patients conditions varying complexityusing north carolina medicaid claims data hospitaldischarged patients april 2012 march 2013 constructed variables indicating whether patients received followup visits within successive intervals whether patients readmitted within 30 days constructed 7 clinical risk strata based 3m clinical risk groups crgs determined expected readmission rates within crg applied survival modeling identify groups appear benefit outpatient followup within 3 7 14 21 30 days dischargethe final study sample included 44473 medicaid recipients 65085 qualifying discharges benefit early followup varied according baseline readmission risk example followup within 14 days discharge associated 15point reduction readmissions lowest risk strata p 001 191point reduction highest risk strata p 001 followup within 7 days associated meaningful reductions readmission risk patients multiple chronic conditions greater 20 baseline risk readmission group represented 24 discharged patientsmost patients meaningfully benefit early outpatient followup transitional care resources would best allocated toward ensuring highest risk patients receive followup within 7 days