Elderly/Long-Term Care

Early followup with a physician reduces readmissions for Medicare patients hospitalized for heart failure

Medicare patients treated for heart failure receiving early physician followup (within 7 days after hospital discharge) are less likely to be readmitted for additional treatment within 30 days of discharge than patients without early followup, a new study finds. Potentially avoidable readmissions for all Medicare hospitalizations cost Medicare up to a fifth ($17 billion) of its hospital costs. For the heart failure study, 21.3 percent of the patients were readmitted within 30 days of discharge. The median rate for early followup among the included hospitals was 38.3 percent of patients.

The 30-day readmission rate for patients whose hospitals were in the lowest (first) quartile of early followup was 23.3 percent compared with a significantly lower rate of 20.5-20.9 percent for hospitals in the second or higher quartiles. Only 7.5 percent of the patients getting early followup saw a cardiologist. Early followup by a cardiologist resulted in a significantly lower 30-day death rate for patients treated in hospitals with the highest versus lowest quartiles of early followup by a cardiologist.

The researchers used data from inpatient Medicare claims from 2003 through 2006 for patients over 65 years old who were in two national heart failure patient registries that included patients from 225 hospitals. Transfers to or from another hospital or heart-related emergency department visits that did not result in hospitalization were not counted as readmissions. The researchers suggest that models of care that include the use of nurse practitioners or physician assistants under physician supervision may allow more heart failure patients to be seen early after their hospital discharge. The study was funded in part by the Agency for Healthcare Research and Quality (HS16964).

More details are in "Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure," by Adrian F. Hernandez, M.D., M.H.S., Melissa A. Greiner, M.S., Gregg C. Fonarow, M.D., and others, in the May 2010 Journal of the American Medical Association 303(17), pp. 1716-1722.

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