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Cited by 51Hospital Admissions and OutcomesHeart Failure Treatment and ManagementPrimary Care and Health Outcomes

Association of early physician follow-up with readmission among patients hospitalized for acute myocardial infarction, congestive heart failure, or chronic obstructive pulmonary disease

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Saxena, Farah E., Bierman, Arlene S., Glazier, Richard H., Wang, Xuesong, Guan, Jun, Lee, Douglas S., Stukel, Therese A.·2022·JAMA Network Open
DOI 10.1001/jamanetworkopen.2022.22056PMC PMC9277500
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Abstract

Importance: A better understanding of the association between early physician follow-up after discharge and adverse outcomes among hospitalized patients may inform interventions aimed at reducing readmission for common chronic conditions. Objective: To assess whether hospitalized patients with early physician follow-up after discharge had lower rates of overall and condition-specific readmissions within 30 days and 90 days of discharge. Design, Setting, and Participants: This cohort study was conducted among Ontario, Canada, adults with first admission for acute myocardial infarction (AMI), congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD) during 2005 to 2019. The exposure was follow-up visit with a primary care physician or relevant specialist within 7 days of discharge. Cox proportional hazards models were used to compare patients with vs without early follow-up, adjusting for sociodemographic factors and comorbidities, weighting by propensity score-based overlap weights. Data were analyzed from January through July 2021. Main Outcomes and Measures: Primary outcomes were 30-day and 90-day readmissions, cardiac readmissions (readmission for AMI, CHF, or angina) for patients with cardiac conditions, and COPD-related readmissions for patients with COPD. Mortality at 30 days and 90 days was a secondary outcome. All percentages reported in Results are unweighted. Results: The study cohort comprised 450 746 patients, including 198 854 patients with AMI, 133 058 patients with CHF, and 118 834 patients with COPD; the median (IQR) age was 66 (56-77) years for AMI, 78 (68-85) years for CHF, and 73 (64-81) years for COPD, and there were 64 339 (32.35%) women, 62 575 (47.03%) women, and 59 179 (49.80%) women, respectively. There were 91 182 patients (45.85%), 56 491 patients (42.46%), and 40 159 patients (33.79%), respectively, who received an early follow-up visit. Overall, patients with early follow-up had higher rates of collaborative care (eg, CHF: 20 931 patients [37.85%] vs 11 101 of 76 567 patients [14.85%]) and visits to a specialist within 30 days (eg, CHF: 25 797 patients [45.67%] vs 20 548 patients [26.84%]). Those with early follow-up had lower 90-day readmission rates among patients with CHF (15 934 patients [28.21%] vs 23 121 patients [30.20%]; adjusted hazard ratio [aHR], 0.98; 95% CI, 0.96-0.99) and among those with COPD (8784 patients [21.87%] vs 18 097 of 78 675 patients [23.00%]; aHR, 0.95; 95% CI, 0.93-0.98). Among patients with COPD, those with early follow-up had lower 90-day COPD-related readmission rates (4015 patients [10.00%] vs 8449 patients [10.74%]; aHR, 0.93; 95% CI, 0.89-0.96), and among patients with CHF, those with early follow-up had lower 90-day mortality rates (4044 patients [7.16%] vs 6281 patients [8.20%]; aHR, 0.93; 95% CI, 0.90-0.97). There were no significant benefits at 30 days or for patients with AMI. Conclusions and Relevance: These findings suggest that early follow-up in conjunction with a comprehensive transitional care strategy for hospitalized patients with medically complex conditions coupled with ongoing effective chronic disease management may be associated with reduced 90-day readmissions.

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  • The 3-month timeframe is clinically and operationally significant as the hospital's diabetes case manager follows up on discharged patients during this period, frequently identified as the high-risk period in the literature.

    “The 3-month timeframe is clinically and operationally significant as the hospital’s diabetes case manager follows up on discharged patients during this period, frequently identified as the high-risk period in the literature [39–41].”

    From Machine learning-driven risk prediction for post-hospitalization diabetes case management: Integrating clinical and social determinants of health (2026) · cites this paper as [39]

    The Introduction (page unavailable) calls the days immediately after discharge a period of increased risk. The Methods follow patients for 90 days, but the paper does not identify the entire three-month period as high risk; it studies patients hospitalized for AMI, CHF, or COPD, not diabetes patients. (LLM, conf=0.82)

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Authors
Saxena, F. E., Bierman, A. S., Glazier, R. H., Wang, X., Guan, J., Lee, D. S., & Stukel, T. A.
Affiliations
  • Canadian Partnership Against Cancer (CA)
  • Agency for Healthcare Research and Quality (US)
  • St. Michael's Hospital (CA)
  • Institute for Clinical Evaluative Sciences (CA)
  • University of Toronto (CA)
  • ICES, Toronto, Ontario, Canada
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2022-07-12
Volume
5
Issue
7
Pages
e2222056
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2022.22056
PMC
PMC9277500
OpenAlex
W4285078476
Cited by
51
References
45
Citations by year
2026: 16 · 2025: 15 · 2024: 16 · 2023: 4
FWCI
9.66
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion)
Funders
  • Ontario Ministry of Health and Long-Term Care
  • University of Toronto
  • Canadian Institutes of Health Research (143303_1, 143303)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
hospital readmission, acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, post-discharge care, primary care follow-up, 30-day readmission, 90-day readmission, post-discharge mortality, cardiac readmission, propensity score overlap weighting
MeSH terms
Adult, Aged, Female, Follow-Up Studies, Heart Failure, Humans, Male, Myocardial Infarction, Ontario, Patient Readmission, Physicians, Cohort Studies, Pulmonary Disease, Chronic Obstructive

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