Examination of Post-discharge Follow-up Appointment Status and 30-Day Readmission

Abstract

Background: Post-hospital discharge follow-up appointments are intended to evaluate patients’ recovery following a hospitalization, but it is unclear how appointment statuses are associated with readmissions. Objective: To examine the association between post-discharge ambulatory follow-up status, (1) having a scheduled appointment and (2) arriving to said appointment, and 30-day readmission. Design and Setting: A retrospective cohort study of patients hospitalized at 12 hospitals in an Integrated Delivery Network and their ambulatory appointments in that same network. Patients and Main Measures: We included 50,772 patients who had an ambulatory appointment within 18 months of an inpatient admission in 2018. Primary outcome was readmission within 30 days post-discharge. Key Results: There were 32,108 (63.2%) patients with scheduled follow-up appointments and 18,664 (36.8%) patients with no follow-up; 28,313 (88.2%) patients arrived, 3149 (9.8%) missed, and 646 (2.0%) were readmitted prior to their scheduled appointments. Overall 30-day readmission rate was 7.3%; 6.0% [5.75–6.31] for those who arrived, 8.8% [8.44–9.25] for those without follow-up, and 10.3% [9.28–11.40] for those who missed a scheduled appointment (p < 0.001). After adjusting for covariates, patients who arrived at their appointment in the first week following discharge were significantly less likely to be readmitted than those not having any follow-up scheduled (medical adjusted hazard ratio (aHR) 0.57 [0.47–0.69], p < 0.001; surgical aHR 0.58 [0.44–0.75], p < 0.001) There was an increased risk at weeks 3 and 4 for medical patients who arrived at a follow-up compared to those with no follow-up scheduled (week 3 aHR 1.29 [1.10–1.51], p = 0.001; week 4 aHR 1.46 [1.26–1.70], p < 0.001). Conclusions: The benefit of patients arriving to their post-discharge appointments compared with patients who missed their follow-up visits or had no follow-up scheduled, is only significant during first week post-discharge, suggesting that coordination within 1 week of discharge is critical in reducing 30-day readmissions.