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Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis
Author(s) -
Kanwal Fasiha,
Asch Steven M.,
Kramer Jennifer R.,
Cao Yumei,
Asrani Sumeet,
ElSerag Hashem B.
Publication year - 2016
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.28558
Subject(s) - medicine , cirrhosis , hazard ratio , retrospective cohort study , confidence interval , outpatient clinic , cohort , emergency medicine , pediatrics
Preventing readmission has been the focus of numerous quality improvement efforts across many conditions. Early outpatient follow‐up has been proposed as the best mechanism for reducing readmissions. The extent to which early outpatient follow‐up averts readmission or improves outcomes in cirrhosis is not known. We evaluated the relationship between early outpatient follow‐up and short‐term readmission and mortality in patients with cirrhosis. We conducted a retrospective cohort study of patients with cirrhosis who were hospitalized with a liver‐related diagnosis and discharged to home from 122 Veterans Administration hospitals between 2010 and 2013. We defined early follow‐up as an outpatient visit with a clinician within 7 days after discharge. We propensity matched patients who received early visit with those who did not have any visit and examined the associations between early follow‐up and all‐cause readmission and mortality within 8‐30 days after discharge. Of 25,217 patients hospitalized with cirrhosis, 8,123 (32.2%) had an early follow‐up visit within 7 days of discharge. A total of 3,492 (13.8%) patients were readmitted and 1,185 (4.6%) died between 8 and 30 days after discharge. In the propensity‐matched sample (N = 16,238), patients with early outpatient follow‐up visit had a slightly higher risk of readmission (15.3% vs. 13.8%; hazard ratio [HR] =1.10; 95% confidence interval [CI] = 1.02‐1.19), but significantly lower risk of mortality (3.2% vs. 5.2%; HR = 0.60; 95% CI = 0.51‐0.70) than those without early visit. The findings persisted in several subgroup and sensitivity analyses. Conclusions : Early outpatient follow‐up after discharge was associated with a small increase in readmissions but lower overall mortality in patients with cirrhosis. Transitional care may be effective in improving short‐term outcomes in patients with cirrhosis, but readmission performance measures would miss this effect. (H epatology 2016;64:569‐581)