Patients should see hospital physicians after discharge

Patients should see hospital physicians after discharge Patients are significantly less likely to die or be readmitted to hospital if they are followed-up by the physician who treated them in hospital, a new study from the Institute for Clinical Evaluative Sciences (ICES) shows.

Researchers followed over 938,000 adults discharged from Ontario hospitals between 1995 and 2000. They examined differences in mortality and hospital readmission rates within 30 days of hospital discharge for patients seen by physicians who treated them in the hospital, physicians who treated them 3 months prior to their hospital admission (community physicians), and specialists.

Results:

• During the first 30 days after discharge, 70% of patients had at least one visit with a hospital physician.
• Of the patients studied, 7.7% died or were readmitted to hospital. The risk of hospital readmission or death was reduced to 7.3%, 7.0%, and 6.7% if patients had 1, 2, or 3 visits, respectively, with a hospital rather than a community physician. This risk reduction was adjusted for other important patient, illness and physician factors (including specialty).

Implications:

“Although these results may seem like small improvements, the fact that we can reduce hospital readmissions and mortality with each visit to a hospital physician rather than another physician translates into a major impact on outcomes for thousands of patients,” said lead author and ICES scientist Dr. Carl van Walraven.

“Hospital physicians are more likely to have all the information about the patients at their fingertips and be more familiar with what happened to the patient during their hospitalization. This could avoid patient complications down the road. As well, in knowing how sick the patient was during their hospital stay, hospital physicians may be less likely to unnecessarily readmit them to hospital during the early follow-up period when they still may appear very ill.”

Dr. van Walraven adds that community physicians or specialists who do treat patients after hospital discharge should ensure they have access to as much information as possible regarding the hospitalization.

The study “Continuity of care and patient outcomes after hospital discharge”, is in the June 8, 2004 issue of the Journal of General Internal Medicine.

Author affiliations: ICES (Drs. van Walraven, Mamdani, Fang, and Austin); Faculty of Medicine, University of Ottawa (Dr. van Walraven); Clinical Epidemiology Program, Ottawa Health Research Institute (Dr. van Walraven); Faculties of Medicine (Dr. Austin) and Pharmacy (Dr. Mamdani), University of Toronto.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Julie Argles
• Media Relations Officer, ICES
• (416) 480-4055 ext. 3602 or cell (416) 432-8143