Examination of Post-discharge Follow-up Appointment Status and 30-Day Readmission

Background Post-hospital discharge follow-up appointments are intended to evaluate patients’ recovery following a hospitalization, but it is unclear how appointment statuses are associated with readmissions. Objective To examine the association between post-discharge ambulatory follow-up status, (1) having a scheduled appointment and (2) arriving to said appointment, and 30-day readmission. Design and Setting A retrospective cohort study of patients hospitalized at 12 hospitals in an Integrated Delivery Network and their ambulatory appointments in that same network. Patients and Main Measures We included 50,772 patients who had an ambulatory appointment within 18 months of an inpatient admission in 2018. Primary outcome was readmission within 30 days post-discharge. Key Results There were 32,108 (63.2%) patients with scheduled follow-up appointments and 18,664 (36.8%) patients with no follow-up; 28,313 (88.2%) patients arrived, 3149 (9.8%) missed, and 646 (2.0%) were readmitted prior to their scheduled appointments. Overall 30-day readmission rate was 7.3%; 6.0% [5.75–6.31] for those who arrived, 8.8% [8.44–9.25] for those without follow-up, and 10.3% [9.28–11.40] for those who missed a scheduled appointment ( p < 0.001). After adjusting for covariates, patients who arrived at their appointment in the first week following discharge were significantly less likely to be readmitted than those not having any follow-up scheduled (medical adjusted hazard ratio (aHR) 0.57 [0.47–0.69], p < 0.001; surgical aHR 0.58 [0.44–0.75], p < 0.001) There was an increased risk at weeks 3 and 4 for medical patients who arrived at a follow-up compared to those with no follow-up scheduled (week 3 aHR 1.29 [1.10–1.51], p = 0.001; week 4 aHR 1.46 [1.26–1.70], p < 0.001). Conclusions The benefit of patients arriving to their post-discharge appointments compared with patients who missed their follow-up visits or had no follow-up scheduled, is only significant during first week post-discharge, suggesting that coordination within 1 week of discharge is critical in reducing 30-day readmissions.