Timely follow-up after hospitalization may reduce disparities in readmissions

In a retrospective cohort study of Medicare beneficiaries, follow-up within seven days of discharge was associated with reduced 30-day readmissions and was predicted to help mitigate higher readmission rates among Black and dual-eligible patients.

Improving timely follow-up after hospitalization may reduce readmissions and help mitigate readmission disparities, a recent study found.

Researchers used Medicare data to perform a retrospective cohort study estimating the associations between sociodemographic characteristics and readmissions in patients hospitalized for the Hospital Readmissions Reduction Program's (HRRP) priority conditions, as well as whether follow-up within seven days of discharge might improve readmission disparities. Patients were included in the study if they were Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, or pneumonia and discharged home between Jan. 1 and Dec. 1, 2018. The main outcome measure was all-cause unplanned readmission within 30 days after discharge. The results were published March 30 by the Journal of General Internal Medicine.

Data from 749,402 patients were analyzed. Just over half (50.4%) were women, 63.2% were between 65 to 84 years of age, and 79.1% were of non-Hispanic White ethnicity. Overall, 27.7% were considered dual-eligible. The overall rate of follow-up within seven days of discharge was 43.6%, ranging from 34.1% in non-Hispanic Black patients to 45.3% in non-Hispanic White patients. Dual-eligible beneficiaries were less likely to receive timely follow-up (38.4% vs. 45.7%), as were those in metropolitan versus rural areas (43.3% vs. 44.8%). Rate of follow-up decreased as area-level social deprivation increased.

The readmission rate within 30 days was 16.2% for the entire cohort. Postdischarge follow-up within seven days of discharge was associated with a substantially lower risk of readmission (hazard ratio, 0.52; 95% CI, 0.52 to 0.53). For all HRRP conditions, risk for readmission was higher in dual-eligible beneficiaries and those who lived in areas with high social deprivation. Readmission risk after pneumonia hospitalization was higher for non-Hispanic Black beneficiaries than for non-Hispanic Whites (hazard ratio, 1.05; 95% CI, 1.01 to 1.09). A mediation analysis suggested that follow-up within seven days of discharge would mediate 21.2% of the disparity in readmission risk between dual-eligible and non-dual-eligible beneficiaries and 50.7% of that between beneficiaries living in areas with the highest versus lowest social deprivation. In addition, follow-up within seven days of discharge appeared to mediate 97.5% of the increased readmission risk between non-Hispanic Black and non-Hispanic White beneficiaries.

The researchers noted that their results could be affected by confounding and that they used area-level demographic characteristics as a proxy for social risk factors, among other limitations. They concluded that timely follow-up after hospitalization for HRRP priority conditions was associated with lower readmission rates in Medicare beneficiaries. “In addition, timely follow-up was associated with reduced disparities in readmission across conditions for the dually eligible (compared to beneficiaries who are not dually eligible) and reduced the increased risk among non-Hispanic Black beneficiaries hospitalized with pneumonia,” they wrote. “Future research should assess the drivers of disparities in timely follow-up to inform interventions.”