Follow-up PCP visits again shown to reduce hospital readmissions

Key takeaways:

• Patients with emergency general surgery conditions — whether they underwent an operation or not — were less likely to be readmitted if they saw a PCP after discharge.
• PCP visits allow for increased surveillance.

Patients admitted for an emergency general surgery condition had nearly 70% reduced odds of readmission if they had a primary care physician follow-up visit within 30 days of discharge, a study found.

“In [emergency general surgery (EGS)] specifically, 8.1% of all patients experience an unplanned readmission, with particularly increased risk among adults with preexisting comorbidities and extended hospital stays, a pattern also observed in major elective surgery,” Adora N. Moneme, BS, from the University of Pennsylvania Perelman School of Medicine, and colleagues wrote in JAMA Surgery.

Although prior research has shown that PCP follow-up after high-risk surgery was linked to reduced readmissions, “little is known about the implications of primary care for both operatively and nonoperatively managed patients” the researchers noted.

Moneme and colleagues evaluated a cohort of 345,360 Medicare beneficiaries aged 66 years and older who were admitted for an EGS condition from 2016 to 2018, determining readmission rates based on PCP follow-up and operative treatment. EGS conditions included general abdominal, colorectal, hepatopancreatobiliary, intestinal obstruction, hernia and upper gastrointestinal.

Of the cohort, 45% had a PCP follow-up visit, 31.4% received operative treatment during their index admission and 17.5% were readmitted within 30 days after their discharge.

Moneme and colleagues found that patients who had a PCP follow-up had 67% lower odds of readmission (adjusted OR = 0.33; 95% CI, 0.31-0.36) compared with those without a PCP follow-up.

Additionally, patients who were treated operatively during their index admission and had a PCP follow-up within 30 days of discharge had 79% reduced odds of readmission (aOR = 0.21; 95% CI, 0.18-0.25).

Reduced odds of readmission after a PCP follow-up within 30 days of discharge were likewise seen for patients treated nonoperatively (aOR = 0.36; 95% CI, 0.34-0.39).

The researchers also found that chronic kidney disease, heart failure and acute kidney failure were among the top diagnoses for both the overall cohort and treatment subgroups.

Moneme and colleagues explained that as evidence of nonoperative treatment being favorable for several surgical diseases grows, in addition to increasing usage of such treatment, “it is critical to understand the implications of postdischarge interventions for both operatively and nonoperatively treated patients.”

They also noted that because the transition period from the hospital to home is one with an increased risk for adverse events and health deterioration, “follow-up with a PCP provides an opportunity for increased surveillance in the outpatient setting.”

“[PCPs] can identify discharge medication errors, identify and intervene in early-stage infection, and manage chronic disease destabilization due to the stress of hospitalization,” the researchers wrote. “Moreover, improved care coordination during the transition from hospital to home has been associated with reduced rates of readmission.”