A visit from a primary care clinician that focuses on following up on treatment plans after a patient’s discharge from a hospital stay lowers the risk of readmission.
A study by Kaiser Permanente found that tailored post-hospital visits lowered readmissions for Medicare Advantage patients. The 20-minute visits are scheduled for patients while they are still in the hospital and focus specifically on follow-up treatment plans, according to the study published in JAMA Internal Medicine. In contrast, regular outpatient visits by a primary care clinician may focus on routine care and not cover specific issues related to the recent hospitalization.
Researchers reviewed the electronic health records of more than 71,000 Medicare Advantage patients discharged from 14 Kaiser Permanente hospitals from 2011 to 2014. The study found patients who had one or more visits within seven days of being discharged home were 12% to 24% less likely to be readmitted to the hospital than those who did not have an outpatient visit from a clinician.
Patients who had a visit tailored to address their post-discharge treatment plans—called a POSH visit—were 28% less likely to experience readmission.
“Although any primary care clinician outpatient visit appeared to reduce readmission risk compared to no outpatient visit, the POSH visit provides the added benefit of the care team being alerted to, and therefore better prepared to address, patients' post-discharge needs," Ernest Shen, Ph.D., research scientist biostatistician at the Kaiser Permanente Southern California Department of Research & Evaluation, said in an announcement.
The POSH visits focused on a patient’s immediate post-discharge needs and allowed the clinicians to assess the person’s clinical status, determine if more intensive treatment was needed, follow-up on test results and referrals, review medications and provide patient and family education.
The research is important as one analysis projected more than half of U.S. hospitals would be penalized for excessive 30-day readmission rates this year, with Medicare withholding more than half a billion in payments.