The Association of Early Physician Follow-Up and 30-Day Readmission After Non-ST-Segment Elevation Myocardial Infarction Among Older Patients
What is the relationship between hospital-level physician follow-up within 7 days of discharge and 30-day all-cause readmission in elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI)?
The authors analyzed data from the CRUSADE Registry linked with Medicare claims from 2003-2006, for 25,872 NSTEMI patients ≥65 years old discharged home from 228 hospitals. Logistic regression was used to study the relation between 30-day all-cause readmission and physician follow-up within 7 days after discharge after adjusting for patient, treatment, and hospital characteristics.
Early follow-up at hospitals varied between 2.6% and 51.6% with median hospital-level percentage of patients receiving early physician follow-up of 23.3% (interquartile range, 17.1%-29.1%). Overall, 18.5% of patients were readmitted within 30 days of index hospitalization. Unadjusted and adjusted rates of 30-day readmission did not differ among quartiles of hospital-level early physician follow-up. Each 5% increase in hospital early follow-up was associated with no change in risk for readmission (adjusted odds ratio, 0.99; 95% confidence interval, 0.97-1.02; p = 0.60). Similarly, there was no association between early follow-up and 30-day all-cause mortality or readmission for cardiovascular causes.
The authors concluded that there was no association between early follow-up and readmission after NSTEMI.
Readmission after acute MI is publically reported, and is linked to hospital reimbursement. The high cost of these readmissions has resulted in policies aimed towards rewarding institutions with low readmission rates, although there are few studies to guide how this can be accomplished. This study suggests that early physician follow-up is unlikely to be effective at achieving a reduction in readmission after MI, and other strategies need to be explored to affect a reduction in rehospitalizations in this population.
Keywords: Physicians, Myocardial Infarction, Follow-Up Studies, Patient Readmission, Medicare, Patient Discharge
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