6, 8 With the move toward pay for performance, the Medicare Payment Advisory Commission has proposed reducing payments for hospital readmissions. Estimates suggest that avoidable hospital readmissions cost Medicare up to $12 billion per year. Strategies to reduce hospital readmissions are important to provide quality health care and to save costs owing to the expense of hospital readmissions. 1, 2 These high rates of adverse events, emergency department visits, and readmissions after hospital dismissal are thought to result in part from discharge processes that are not optimal. 6 These striking statistics underscore the vulnerability of patients during their transition from the hospital to home or another care setting. 5 In the Medicare population alone, 19.6% of patients dismissed from the hospital will be readmitted within 30 days and 34.0% of patients will be readmitted within 60 days. 1 - 4 Previous research has suggested that an adverse event complicates 1 of every 5 hospital discharges, often leading to an emergency department visit or hospital readmission. One measure of care improvement can be accomplished by decreasing avoidable hospital readmission. Health care professionals are ethically charged with providing patients with the best quality care possible. Therefore, national efforts to ensure follow-up for all patients after hospital dismissal may not be beneficial or cost-effective. However, those with a documented follow-up appointment were slightly more likely to have an adverse event (hospital readmission, emergency department visit, or death) within 180 days after dismissal.Ĭonclusions Improved discharge processes, including arrangement of hospital follow-up appointments, do not appear to improve readmission rates or survival in general medicine patients. No difference was found between those with a documented follow-up appointment vs those without regarding hospital readmission, emergency department visits, or mortality 30 days after dismissal. Results Of the 4989 dismissal summaries, 3037 (60.9%) contained instructions for a follow-up appointment. Survival analysis and propensity score–adjusted proportional hazards regression models were developed to investigate the association of follow-up appointment arrangements with hospital readmission, emergency department visits, and mortality at 30 and 180 days after discharge. Methods For this study, we reviewed hospital dismissal instructions for general medicine patients dismissed in 2006 from Mayo Clinic hospitals in Rochester, Minnesota (n = 4989), and determined whether specific appointment details for follow-up were documented.

Although research has demonstrated a correlation between follow-up arrangements and reduced hospital readmission in specific patient populations, the effect of hospital follow-up in general medicine patients has not been assessed. Interventions recently proposed by the Centers for Medicare and Medicaid Services to reduce avoidable hospital readmissions include providing patients with clear discharge instructions and appointments for timely follow-up visits. Shared Decision Making and Communicationīackground Decreasing hospital readmission and patient mortality after hospital dismissal is important when providing quality health care.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.

Follow up appointment