Medical Research: What is the background for this study? What are the main findings?
Dr. Tsai: Emerging evidence is suggesting that fragmented care is associated with higher costs and lower quality. For elderly patients undergoing major surgical procedures, fragmentation of care in the post-discharge period may be especially problematic. We therefore hypothesized that elderly patients receiving fragmented post-discharge care would have worse outcomes. We found that among Medicare patients who are readmitted after a major surgical operation, one in four are readmitted to a different hospital than the one where the original operation was performed. Even taking distance traveled into account, we find that this type of postsurgical care fragmentation is associated with a substantially higher risk of death.
Medical Research: What should clinicians and patients take away from your report?
Dr. Tsai: Especially for older patients with complex medical needs, every effort should be made to ensure continuity of surgical care. In the preoperative period, the surgical team should help the patient make appropriate plans for recovery after the patient is discharged. In the hospital, careful care coordination is needed to ensure that discharge information and changes to medications are discussed with the patient and that the patient understands his or her postoperative recovery plan. In the post-discharge period, early follow-up may help to preempt any potential readmission. From a systems standpoint, better health information exchange among hospitals and health care providers can help improve continuity of care for older patients with complex medical needs.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Tsai: First, we need to better understand the mechanisms linking fragmented post-discharge care to worse outcomes. Future research on both the patient and hospital factors that contribute to fragmented care will help inform potentially different strategies focused on either better interventions targeted at high-risk patients or improving barriers to high-quality post-discharge care.
Second, once we understand what these mechanisms are, further research may be needed in order to understand which interventions actually work in the real-world setting.
Tsai TC, Orav E, Jha AK. Care Fragmentation in the Postdischarge Period: Surgical Readmissions, Distance of Travel, and Postoperative Mortality. JAMA Surg. 2015;150(1):59-64. doi:10.1001/jamasurg.2014.2071.