Ambulatory Follow-up and Outcomes Among Medicare Beneficiaries After Emergency Department Discharge.
JAMA Netw Open
; 3(10): e2019878, 2020 10 01.
Article
em En
| MEDLINE
| ID: mdl-33034640
ABSTRACT
Importance Ambulatory follow-up care is frequently recommended after an emergency department (ED) visit. However, the frequency with which follow-up actually occurs and the degree to which follow-up is associated with postdischarge outcomes is unknown. Objectives:
To examine the frequency and variation in ambulatory follow-up among Medicare beneficiaries discharged from US EDs and the association between ambulatory follow-up and postdischarge outcomes. Design, Setting, andParticipants:
This cohort study of 9â¯470â¯626 ED visits to 4728 US EDs among Medicare beneficiaries aged 65 and older from 2011 to 2016 who survived the ED visit and were discharged to home used Kaplan-Meier curves and proportional hazards regression. Data analysis was conducted from December 2019 to July 2020. Exposures Ambulatory follow-up after discharge from the ED. Main Outcomes andMeasures:
Postdischarge mortality, subsequent ED visit, or inpatient hospitalization within 30 days of an index ED visit.Results:
The study sample consisted of 9â¯470â¯626 index outpatient ED visits to 4684 EDs; most visits (5â¯776â¯501 [61.0%]) were among women, and the mean (SD) age of patients was 77.3 (8.4) years. In this sample, the cumulative incidence of ambulatory follow-up was 40.5% (3â¯822â¯133 patients) at 7 days and 70.8% (6â¯662â¯525 patients) at 30 days, after accounting for censoring and for mortality as a competing risk. Characteristics associated with lower rates of ambulatory follow-up included beneficiary Medicaid eligibility (hazard ratio [HR], 0.77; 95% CI, 0.77-0.78; P < .001), Black race (HR, 0.82; 95% CI, 0.81-0.83; P < .001), and treatment at a rural ED (HR, 0.75; 95% CI, 0.73-0.77; P < .001) in the multivariable regression model. Ambulatory follow-up was associated with lower risk of postdischarge mortality (HR, 0.49; 95% CI, 0.49-0.50; P < .001) but higher risk of subsequent inpatient hospitalization (HR, 1.22; 95% CI, 1.21-1.23; P < .001) and ED visits (HR, 1.01; 95% CI, 1.00-1.01; P < .001), adjusting for visit diagnosis, patient demographic characteristics, and chronic conditions. Conclusions and Relevance In this cohort study of Medicare beneficiaries discharged from the ED, nearly 30% lacked ambulatory follow-up at 30 days, with variation in follow-up rates by patient and hospital characteristics. Having an ambulatory follow-up visit was associated with higher risk of subsequent hospitalization but lower risk of mortality. Ambulatory care access may be an important driver of clinical outcomes after an ED visit.
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Base de dados:
MEDLINE
Assunto principal:
Alta do Paciente
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Assistência ao Convalescente
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Serviço Hospitalar de Emergência
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Assistência Ambulatorial
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Serviços de Saúde para Idosos
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article