Use of Hospital-Based Acute Care Among Patients Recently Discharged From the Hospital
What are patterns of hospital-based acute medical and surgical care within 30 days of discharge from acute care hospitals?
This was a prospective study of patients discharged between 2008-2009 from acute care hospitals in California, Florida, and Nebraska (n = 5,032,254 index hospitalizations), using population-based, multi-payer databases. The primary outcomes were: emergency department (ED) visits not resulting in admission (treat-and-release visits), all-cause hospital readmissions, and a combined measure of ED visits and hospital readmissions (hospital-based acute care). A condition-specific ED index was created to delineate the use of ED treat-and-release visits within condition-specific subgroups.
Approximately 18% of hospital discharges were followed by at least one hospital-based acute care encounter within 30 days, including 147.6 readmissions and 97.5 ED treat-and-release visits for every 1,000 discharges. Of the 470 index discharge conditions, 25.7% had higher ED revisit rates than readmission rates (ED index >1); the ED index for “heart failure and shock” was 0.35. Approximately one-third of hospital-based acute care use occurred during the first 7 days following hospital discharge (35.3% [95% confidence interval (CI), 35.1%-35.4%] of ED visits and 31.9% [95% CI, 31.7%-32.0%] of readmissions). The highest overall use rates for hospital-based acute care were for heart failure (373.5 [95% CI, 370.0-377.0] encounters/1,000 discharges) and psychosis (470.8 [95% CI, 467.7-474.0] encounters/1,000 discharges).
Among three geographically diverse states, ED visits within 30 days of discharge from acute care hospitals were common, and accounted for nearly 40% of post-discharge hospital-based acute care. The use of hospital-based acute care within 30 days of discharge from an index hospitalization was particularly high for heart failure.
The authors of this population-based study of over 5 million index hospitalizations have convincingly demonstrated high rates of ED treat-and-release visits following index hospitalizations for a range of medical and surgical diagnoses. These findings are a reminder that transitional care and efforts to reduce the use of unnecessary hospital-based acute care following an index hospitalization cannot only focus on readmissions, but must also account for ED visits. The role of the ED during the post-discharge period should be clarified, particularly since the findings from this analysis demonstrate that many patients present to the ED for reasons related to their index admission. There are opportunities for anticipating care needs and improving discharge planning.
Keywords: Psychotic Disorders, Shock, California, Patient Readmission, Florida, Heart Failure, Nebraska, Emergency Service, Hospital, Confidence Intervals, Patient Discharge, Hospitalization
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