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Earlier follow-up appointments equaled more adverse events for discharged patients

December 18, 2017

Hospital patients with follow-up visits planned within seven days of discharge had a higher rate of post-discharge adverse events than those with follow-ups scheduled at a later date, a Wayne State University School of Medicine-led study revealed.

The results – 33.5 percent versus 23 percent, respectively – were a surprise to the research team, which aimed to examine whether having a timely follow-up outpatient visit would reduce the risk of post-discharge adverse events.

“We expected that our results would indicate that patients who had scheduled post-discharge follow-up visits sooner would be less, not more, likely to experience a post-discharge adverse event,” said Department of Family Medicine and Public Health Sciences Associate Professor Dionyssios Tsilimingras, M.D. ’95, M.P.H.

Dr. Tsilimingras, co-director of the Michigan Area Health Education Center, led the study team, which included collaborators at WSU, Tallahassee Memorial Hospital in Florida, Florida State University College of Medicine, Brigham and Women’s Hospital, and Harvard Medical School.

The team evaluated 545 patients who from December 2011 through October 2012 were under the care of hospitalist physicians and were discharged home from Tallahassee Memorial Hospital in Florida, spoke English and could be contacted 30 days after discharge.

“Our findings may indicate that hospitalist physicians were accurately identifying patients at discharge deemed to be at high risk for post-discharge problems and therefore scheduled faster follow-up visits with them. This informal risk assessment by clinicians may have been based in part on medical complexity, but also psychosocial complexity, differences in health literacy, perceived stability at discharge or functional status. Finally, patients with faster follow-up may have had better documentation and patient awareness of symptoms that could be collected during the follow-up and outcome adjudication process,” Dr. Tsilimingras added.

“The association of post-discharge adverse events with timely follow-up visits after hospital discharge” was published in the open-access journal PLOS One.

Nearly a third of adults discharged from the hospital are expected to experience an adverse event, which are unpleasant to patients, burdensome to caregivers, expensive for the health care system and may be easier to prevent or ameliorate than hospital readmission. The researchers concluded that further research is needed to determine the relationship between early post-discharge follow-up visits and post-discharge adverse events, including the perceived risk factors that influence the decision to schedule early follow-up, how well they match with actual risk and the likelihood of benefiting from intervention. They also need to better understand the optimal timing and nature of follow-up in different sub-populations of high-risk patients.

The work was supported by a grant from the Agency for Healthcare Research and Quality (R01HS018694), awarded to Dr. Tsilimingras.

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