Does geriatric follow-up visits reduce hospital readmission among older patients discharged to temporary care at a skilled nursing facility: a before-and- after cohort study

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Abstract

Introduction Hospital readmission is a burden to patients, relatives and society. Older patients with frailty are at highest risk of readmission and its negative outcomes. Objective We aimed at examining whether follow-up visits by an outgoing multidisciplinary geriatric team (OGT) reduces unplanned hospital readmission in patients discharged to a skilled nursing facility (SNF). Design A retrospective single-centre before-and-after cohort study. Setting and participants Study population included all hospitalised patients discharged from a Danish geriatric department to an SNF during 1 January 2016-25 February 2020. To address potential changes in discharge and readmission patterns during the study period, patients discharged from the same geriatric department to own home were also assessed. Intervention OGT visits at SNF within 7 days following discharge. Patients discharged to SNF before 12 March 2018 did not receive OGT (-OGT). Patients discharged to SNF on or after 12 March 2018 received the intervention (+OGT). Main outcome measures Unplanned hospital readmission between 4 hours and 30 days following initial discharge. Results Totally 847 patients were included (440 -OGT; 407 +OGT). No differences were seen between the two groups regarding age, sex, activities of daily living (ADLs), Charlson Comorbidity Index (CCI) or 30-day mortality. The cumulative incidence of readmission was 39.8% (95% CI 35.2% to 44.8%, n=162) in -OGT and 30.2% (95% CI 25.8% to 35.2%, n=113) in +OGT. The unadjusted risk (HR (95% CI)) of readmission was 0.68 (0.54 to 0.87, p=0.002) in +OGT compared with -OGT, and remained significantly lower (0.72 (0.57 to 0.93, p=0.011)) adjusting for age, length of stay, sex, ADL and CCI. For patients discharged to own home the risk of readmission remained unchanged during the study period. Conclusion Follow-up visits by OGT to patients discharged to temporary care at an SNF significantly reduced 30-day readmission in older patients.

Original languageEnglish
Article numbere046698
JournalBMJ Open
Volume11
Issue number8
Number of pages8
ISSN2044-6055
DOIs
Publication statusPublished - 13. Aug 2021

Keywords

  • geriatric medicine
  • internal medicine
  • rehabilitation medicine
  • Activities of Daily Living
  • Follow-Up Studies
  • Patient Readmission
  • Humans
  • Patient Discharge
  • Aged
  • Retrospective Studies
  • Skilled Nursing Facilities
  • Cohort Studies

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