28 Jan Primary Care Doctor Visit After Discharge Reduced Hospital Readmission Rates
MedicalResearch.com Interview with:
Dawn Wiest, PhD
Director, Action Research & Evaluation
Camden Coalition of Healthcare Providers
MedicalResearch.com: What is the background for this study?
Response: Understanding the role of care transitions after hospitalization in reducing avoidable readmissions, the Camden Coalition launched the 7-Day Pledge in 2014 in partnership with primary care practices in Camden, NJ to address patient and provider barriers to timely post-discharge primary care follow-up. To evaluate whether our program was associated with lower hospital readmissions, we used all-payer hospital claims data from five regional health systems. We compared readmissions for patients who had a primary care follow-up within seven days with similar patients who had a later or no follow-up using propensity score matching.
MedicalResearch.com: What are the main findings?
Response: We found significantly lower readmissions at 30 and 90 days after a hospital discharge among patients who saw their primary care provider within seven days of their hospital discharge compared to patients who had later or no primary care follow-up.
MedicalResearch.com: What should readers take away from your report?
Response: Facilitated connection of patients to primary care within seven days of hospital discharge is associated with lower hospital readmissions. The success of the 7-Day Pledge program hinged on relationship-building with patients and practices, and an understanding of the barriers to timely primary care follow-up care in the community.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further research is needed to identify which patients are most likely to benefit from primary care follow-up after hospital discharge. Understanding which post-discharge care pathways are most effective for patients with the most complex needs is also an important next step.
MedicalResearch.com: Is there anything else you would like to add?
Response: UnitedHealthcare and Horizon NJ Health provided financial support for the 7-Day Pledge program, but had no role in the design of the study or interpretation of the findings. The 7-Day Pledge’s success is based on the hard work of primary care practices throughout Camden and the surrounding areas, including: CAMcare, Cooper Ambulatory Pediatrics, Cooper Internal Medicine, Cooper Family Medicine, Fairview Village Family Practice, Osborn Family Health Center, Project H.O.P.E., Reliance Medical Group, and Virtua Primary Care. We also partner with Cooper University Health Care, Jefferson Health’s three New Jersey hospitals, Lourdes Health System, and Virtua Health through the Camden Coalition Health Information Exchange, which provides us with the data we need to run the 7-Day Pledge.
Wiest D, Yang Q, Wilson C, Dravid N. Outcomes of a Citywide Campaign to Reduce Medicaid Hospital Readmissions With Connection to Primary Care Within 7 Days of Hospital Discharge. JAMA Netw Open.2019;2(1):e187369. doi:10.1001/jamanetworkopen.2018.7369
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