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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

3041 — Early Transition to Outpatient Care and Rehospitalization for Heart Failure

Heidenreich PA (VA Palo Alto), Sahay A (VA Palo Alto), Massie BM (VA San Francisco)

Objectives:
The purpose of this study was to determine if early follow-up following a heart failure admission is associated with reduced readmissions.

Methods:
Inpatient data for VA patients admitted with heart failure from 2000 through 2006 with a principal diagnosis for heart failure were linked to outpatient face-face encounter data (CPT codes 99201-99244) that occurred within 14 days of discharge. Patients were excluded if they were not discharged to the community (10%), died within 14 days (6%), or were readmitted within 14 days of discharge (13%). Hospitalization for heart failure as a principal diagnosis during day 15-45 was the primary endpoint. Multivariable models (generalized estimating equations-GEE) were created with one admission per patient that controlled for other demographics, comorbidities, year of visit, and clustering by facility.

Results:
We included 118,280 admissions for 71,963 patients with a principal diagnosis of heart failure. Following discharge, 52% had no provider visits within 14 days, 42% were seen by a non-cardiology provider, and 6% by a cardiology provider. During the subsequent 30 days (day 15 to day 45) the readmission rate with a principal diagnosis of heart failure to a VA facility was 8.2%. Those without early follow-up had a much higher rate of readmission (13%) compared to those seen early by cardiology (1.7%) or other provider (1.8%). In GEE models that controlled for patient characteristics, year of admission, and clustering within station, an early visit remained significantly associated with reduced chance for readmission compared to no visit -- odds ratio if cardiology visit 0.14, 95% CI (0.11 – 0.20); odds ratio if other visit 0.12, 95% CI (0.10-0.13).

Implications:
Patients with follow-up within 14 days were less likely to be readmitted for a principal diagnosis of heart failure during the next 30 days.

Impacts:
These results support efforts to improve the transition of care for heart failuire patients by reducing follow-up time to a first appointment.


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