Follow-up Appointments May Not Reduce Readmissions

Improving follow-up appointments is often considered one of the key strategies for reducing costly hospital readmissions, but a new study suggests that better discharge processes don't reduce 30-day readmission rates at all.

While previous research has found that follow-up appointments reduce readmissions for special patient populations, the latest study, which was conducted by Mayo Clinic researchers and appears in the latest Archives of Internal Medicine, examined nearly 5,000 dismissal summaries for general medicine patients discharged in 2006 from Mayo Clinic hospitals in Rochester, MN. While most (60%) patients were discharged with instructions for follow-up appointments, there was no difference in hospital readmission rates, emergency department visits, or mortality rates 30 days after the discharge.

At 180 days, those who had a follow-up appointment were actually more likely to be readmitted or have an adverse event than those who hadn't.

The results suggest that hospitals and physicians still have work to do in determining how to reduce hospital readmissions and even "call into question the concept of using readmissions as a quality indicator for the original hospitalization" because most readmissions were unrelated to the original admission, the authors said in their report.

Reducing re-hospitalization has been a major goal of CMS and the Obama administration, as well as many specialty societies, payers, and state agencies. Just this week, the New Jersey Hospital Association announced a statewide effort to reduce readmissions related to heart failure and CIGNA Corp. contracted with an East Hartford, CT, home health business to tackle the issue.

Readmissions are a big target in the healthcare industry in part because they represent what many consider to be an unnecessary driver of spiraling costs. Return visits to hospitals cost the government nearly $17 billion every year, according to a 2009 report.

But increasing follow-up visits without further studying their efficacy could cost even more money, the authors of the Mayo Clinic study suggest. "As an example, consuming resources for hospital follow-up for a young, healthy patient hospitalized for an acute exacerbation of back pain may not be beneficial."

Focusing on follow-up visits for patients with multiple comorbidities or longer hospital stays may be more effective than a blanket approach to follow-up care, according to the report. However, the researchers caution that more research is needed and acknowledge that the study was limited in scope and did not look into factors such as compliance with follow-up instruction.

Recent pilot projects have succeeded in reducing readmission rates by involving patients in their care and improving quality during the hospitalization, according to a Boston Globe report. For example, the University of Colorado has developed a program to teach patients self-management skills, and the University of Pennsylvania School of Nursing is training nurses to prevent infections and coordinate care during the hospitalization, and then visit the patient at home after discharge.

Although effective discharge processes and timely follow-up is "good medicine," the authors conclude that, "healthcare payers must exercise caution when implementing financial incentives for initiatives that have not been clearly shown to improve outcomes."