Thursday, May 6, 2010

Readmission Rates Are Higher For Patients Without Timely Postdischarge Followup

A recent study of heart failure patients published in the Journal of the American Medical Association had several interesting findings regarding followup care after hospital discharge. First, that patients who do not see a provider within seven days following their discharge are 15% more likely to be readmitted within 30 days. Second, that only 40% of the patients studied had this timely followup.

It is the second point that disturbs me. With our current disjointed system of care between physicians and hospitals there is often a break in the continuity of care for a patient following discharge from a hospital. Hospitals actually do better on follow up of Emergency Department patients who are not admitted. The question is "who's responsibility is it to initiate the follow up visit?" Now it seems to rely on the patient. In heart failure patients things are further complicated by the fact that a cardiologist managed the hospital care. So is it the cardiologist or the primary care physician who should follow up?

The current thinking seems to be blame the hospital by penalizing them for excessive readmission rates. This is simply not fair. While there is the possibility of premature discharge that is the cause of readmission, most are the result of poor postdischarge followup. Some readmissions are not preventable no matter what you do.

The current system is flawed and needs better continuity of care for the patient. This will require much stronger communication between all providers. But the solution to this problem is not to simply penalize hospitals thus forcing the responsibility on them. The answer lies in connecting the current patchwork of independent providers together for the sake of the patient.

More on this later.

Mark Brodeur

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