Center for Research on Health Care, Institute for Clinical Research Education, School of Medicine, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
J Am Geriatr Soc. 2011 Oct;59(10):1947-54. doi: 10.1111/j.1532-5415.2011.03572.x. Epub 2011 Aug 30.
The purpose of this study was to assess the effect of posthospital physician follow-up on readmissions in older adults. Physician follow-up visits after discharge have been promoted as a way to improve outcomes and reduce readmissions, but the evidence base for this recommendation is limited. A retrospective analysis of data from the Medicare Current Beneficiary Survey (MCBS) was conducted for 2001 to 2003. Data were extracted on elderly Medicare beneficiaries with an index hospitalization in 2002, and physician follow-up visits and readmissions within 90 days of discharge were identified. Analysis was conducted with multivariable logistic regression modeling to assess the independent effect on 90-day readmission of any physician follow-up, timing of physician follow-up, and follow-up with only primary care physicians. A generalized linear model was used to assess the effect of physician follow-up on total health expenditures. The analytical sample included 326 beneficiaries; 79% had a physician follow-up visit within 90 days, and 28% were readmitted within 90 days. In multivariable modeling, physician follow-up was negatively associated with 90-day readmissions (odds ratio=0.23, 95% confidence interval=0.13-0.43). Follow-up visits were protective against readmissions regardless of timing of visit and when restricted to those by primary care physicians. Having a follow-up visit was associated with approximately $10,000 lower annual health expenditures. In conclusion, physician follow-up protects against readmission after adjusting for important covariates and is associated with significantly lower expenditures. Future efforts should ensure that patients have adequate physician follow-up.
本研究旨在评估出院后医生随访对老年人再入院的影响。出院后医生随访被认为是改善结局和降低再入院率的一种方法，但这一建议的证据基础有限。对 2001 年至 2003 年 Medicare 现行受益人调查（MCBS）的数据进行了回顾性分析。提取了 2002 年住院的老年 Medicare 受益人的数据，并确定了出院后 90 天内的医生随访和再入院情况。采用多变量逻辑回归模型进行分析，以评估任何医生随访、随访时间以及仅与初级保健医生随访对 90 天再入院的独立影响。采用广义线性模型评估医生随访对总医疗支出的影响。分析样本包括 326 名受益人；79%的人在 90 天内接受了医生随访，28%的人在 90 天内再次入院。在多变量模型中，医生随访与 90 天再入院呈负相关（比值比=0.23，95%置信区间=0.13-0.43）。无论随访时间如何，以及当仅限于初级保健医生进行随访时，随访都能预防再入院。进行随访与每年约 10000 美元的医疗支出减少有关。总之，在调整了重要协变量后，医生随访可预防再入院，且与显著较低的支出相关。未来的努力应确保患者有足够的医生随访。
