Hospital follow-up appointments and patient outcomes-not a panacea

January 01, 0001

Hospital follow-up appointments and patient outcomes-not a panacea

Decreasing hospital readmission and patient mortality after hospital dismissal is important when providing quality health care. Interventions recently proposed by the Centers for Medicare and Medicaid Services to reduce avoidable hospital readmissions include providing patients with clear discharge instructions and appointments for timely follow-up visits. For this study, the US authors reviewed hospital dismissal instructions for general medicine patients dismissed in 2006 (n = 4989), and determined whether specific appointment details for follow-up were documented.

They found: "Of the 4989 dismissal summaries, 3037 (60.9%) contained instructions for a follow-up appointment. No difference was found between those with a documented follow-up appointment vs those without regarding hospital readmission, emergency department visits, or mortality 30 days after dismissal. However, those with a documented follow-up appointment were slightly more likely to have an adverse event (hospital readmission, emergency department visit, or death) within 180 days after dismissal."

The authors concluded: "Improved discharge processes, including arrangement of hospital follow-up appointments, do not appear to improve readmission rates or survival in general medicine patients. Therefore, national efforts to ensure follow-up for all patients after hospital dismissal may not be beneficial or cost-effective."

These observational data don’t demonstrate causality, but they do point out that the intervention of providing follow-up appointments after hospital discharge is of unproven benefit.

For the full abstract, click here.

Arch Intern Med 170(11):955-960, 14 June 2010 © 2010 to the American Medical Association
Effect of Hospital Follow-up Appointment on Clinical Event Outcomes and Mortality. Carrie A. Grafft, Furman S. McDonald, Kari L. Ruud, Juliette T. Liesinger, Matthew G. Johnson, James M. Naessens.

Category: HSR. Health Services Research. Keywords: hospital, readmission, mortality, quality of care, follow-up appointments, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 29 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.