About one-third of adults who have been hospitalized don’t see a physician, nurse practitioner, or physician assistant within 30 days after discharge, according to an analysis conducted by the Center for Studying Health System Change.
The fact that recently discharged patients aren’t receiving care in the community has implications for federal efforts to reduce hospital readmissions, the researchers noted. The findings suggest that there are substantial gaps in coordination of post-discharge care.
"The implication is that reforms specific to one payer and focusing only on care processes within hospitals may fall short unless efforts to coordinate with community providers – and to encourage patients’ access to these providers – receive at least as much attention," Anna Sommers, Ph.D., a senior health researcher at the Center for Studying Health System Change and a coauthor of the study, said in a statement.
Even when patients do show up for post-discharge care, physicians often don’t have access to hospital discharge summaries or to information regarding changed medication regimens. And they may lack hospital test results that could shed light on potential unresolved medical issues, the researchers wrote.
The researchers from the Center for Studying Health System Change offered a range of possible policy changes that could help to improve care coordination, such as including post-acute care in new bundled payment experiments or rewarding primary care practices that focus on keeping high-risk patients out of the hospital.
The study was commissioned by the National Institute for Health Care Reform, a nonprofit, nonpartisan organization established by the International Union (United Auto Workers), Chrysler Group LLC, Ford Motor Co., and General Motors.
Patients were generally more likely to skip the post-discharge visit to the doctor if they were healthier, younger, and did not have serious chronic conditions. However, 46% of patients who did not follow up with a doctor had at least one chronic condition and 36% were in fair or poor physical health, the investigators found.
About 90% of patients reported at initial hospital admission that they had a usual source of care; however, more than 20% said it was very or somewhat difficult to contact their usual doctor by phone about a health problem. More than a third reported that their physicians’ office was very or somewhat difficult to contact after hours.
"These barriers may contribute to some patients not receiving care after discharge, although the prevalence of these barriers was similar for people who received or did not receive care after discharge," the investigators wrote.
Type of insurance did not affect whether patients saw a health care provider within 30 days of discharge. Among adults under age 65 years, about 66% of patients who were publicly insured saw a physician within 30 days after discharge, compared with 70% of privately insured patients. Trends were similar among those aged 65 years and older. About 65% of patients who were dually-eligible for Medicare and Medicaid saw a physician within 30 days, compared with 71% of Medicare beneficiaries with supplemental private (Medigap) insurance.
Overall, the 30-day readmission rates for adults aged 21 years and older was 8.2%. A third of adults (33%) were readmitted to the hospital within 1 year of discharge. The 30-day readmissions rate was significantly higher for patients who were sicker. For instance, adults in excellent or very good health had 30-day readmission rates of 5%, but the readmission rate was more than double that for people in fair or poor health. Readmission rates were also higher for people who had trouble bathing or dressing on their own and for those with two or more chronic conditions.
The researchers also found that more than a quarter (26%) of all 30-day readmissions were for conditions considered unrelated to the initial hospital visit. That number climbed to 37% for readmissions within 1 year. Unrelated readmissions were generally for comorbidities such as hypertension, heart failure, and stroke.
The researchers used data from the 2000-2008 Medical Expenditure Panel Survey (MEPS) to estimate the prevalence of hospital readmissions for all causes for adults aged 21 years and older, excluding obstetrical care. The researchers also analyzed the use of outpatient services within 30 days of discharge.
The study authors did not report any financial conflicts. The study was conducted by the Center for Studying Health System Change. It was commissioned by the National Institute for Health Care Reform, a nonpartisan organization established by the International Union (UAW), Chrysler Group LLC, Ford Motor Co., and General Motors.