Inpatient PCP Visit Prior to Discharge Changes Composite Patient Outcomes

HealthDay News –  An inpatient support-care visit from a primary care physician (PCP) is one method studied to support continuity of care during the transition from the hospital to the community.  In a study published online in the Journal of Hospital Medicine, a supportive-care visit from a PCP prior to inpatient hospitalization discharge is associated with lower composite risks of adverse patient outcomes.

Stacey S. Brener, MSc, and colleagues from the University of Toronto analyzed administrative data from 164,059 hospitalized adults (from 2008 to 2009) and 3,236 PCPs who conducted supportive visits. They determined differences in composite outcomes of death, emergency department visit, or emergent readmission within 30 and 90 days between patients who received a visit from their PCP while hospitalized and those who those who did not.

The researchers found that 12% of patients received visits while hospitalized. Patients who were visited by a PCP prior to discharge had more readmissions, more deaths, and fewer emergency department visits than patients who were not visited. However, after adjustment, visited patients had a lower risk for the composite outcome at 30 days (adjusted odds ratio [aOR], 0.92) and 90 days (aOR, 0.9). In addition, visited patients were more likely to utilize community PCPs and home-care services.

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Summary and Clinical Applicability

In the past, many PCPs would make hospital rounds and manage their patient’s care after hospital admission. Now, however, the growing number of hospitalists means fewer PCPs perform this function, leaving some researchers to believe that gaps of care may exist in the transition from the inpatient to outpatient setting.

In this study, a supportive-care visit from a PCP prior to hospital discharge resulted in lower risks of adverse patient outcomes and increased access to community health services.  Thus, PCPs can have a major role in preventing transition gaps for their hospitalized patients, reducing hospital readmission rates which are currently being measured by the Center for Medicare & Medicaid Services (CMS) as an indicator of quality of care.

During a patient’s hospitalization, the lines of communication should ideally remain open between admitting physicians, hospitalists, and PCPs. An electronic health record (EHR) system can serve as a form of automated notification to PCPs when a patient is admitted, discharged or transferred to the hospital.

Summary and Clinical Applicability by Corinna Panlilio Sison, MD

Reference

Brener SS, Bronksill SE, Comrie R, Huang A, Bell CM. Association between in-hospital supportive visits by primary care physicians and patient outcomes: A population-based cohort study. J Hosp Med. 2016; First published online February 23, 2016 DOI: 10.1002/jhm.2561