Recent functional decline and outpatient follow-up after hospital discharge: a cohort study

BMC Geriatrics

Research

Chi-Ling Joanna Sinn¹  Orly Bogler²  David Kirkwood³  Andrew Costa³  Aaron Jones⁴  Peter C. Austin⁵  Lauren Lapointe-Shaw⁶  Karen Okrainec⁷ 

[1] Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada;Faculty of Medicine, University of Toronto, Toronto, Canada;Institute for Clinical Evaluative Sciences McMaster, Hamilton, Canada;Institute for Clinical Evaluative Sciences McMaster, Hamilton, Canada;Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada;Institute for Clinical Evaluative Sciences, Toronto, Canada;Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada;Institute for Clinical Evaluative Sciences, Toronto, Canada;Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada;Toronto General Hospital Research Institute, Department of Medicine, University Health Network, Toronto, ON, Canada;Institute for Clinical Evaluative Sciences, Toronto, Canada;Toronto General Hospital Research Institute, Department of Medicine, University Health Network, Toronto, ON, Canada;

关键词: Functional decline;    Hospital discharge;    Physician follow-up;    Health services;    Homecare;    Readmissions;   

DOI  :  10.1186/s12877-023-04192-7

 received in 2023-04-04, accepted in 2023-07-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundFunctional decline is common following acute hospitalization and is associated with hospital readmission, institutionalization, and mortality. People with functional decline may have difficulty accessing post-discharge medical care, even though early physician follow-up has the potential to prevent poor outcomes and is integral to high-quality transitional care. We sought to determine whether recent functional decline was associated with lower rates of post-discharge physician follow-up, and whether this association changed during the COVID-19 pandemic, given that both functional decline and COVID-19 may affect access to post-discharge care.MethodWe conducted a retrospective cohort study using health administrative data from Ontario, Canada. We included patients over 65 who were discharged from an acute care facility during March 1st, 2019 – January 31st, 2020 (pre-COVID-19 period), and March 1st, 2020 – January 31st, 2021 (COVID-19 period), and who were assessed for home care while in hospital. Patients with and without functional decline were compared. Our primary outcome was any physician follow-up visit within 7 days of discharge. We used propensity score weighting to compare outcomes between those with and without functional decline.ResultsOur study included 21,771 (pre-COVID) and 17,248 (COVID) hospitalized patients, of whom 15,637 (71.8%) and 12,965 (75.2%) had recent functional decline. Pre-COVID, there was no difference in physician follow-up within 7 days of discharge (Functional decline 45.0% vs. No functional decline 44.0%; RR = 1.02, 95% CI 0.98–1.06). These results did not change in the COVID-19 period (Functional decline 51.1% vs. No functional decline 49.4%; RR = 1.03, 95% CI 0.99–1.08, Z-test for interaction p = 0.72). In the COVID-19 cohort, functional decline was associated with having a 7-day physician virtual visit (RR 1.15; 95% CI 1.08–1.24) and a 7-day physician home visit (RR 1.64; 95% CI 1.10–2.43).ConclusionsFunctional decline was not associated with reduced 7-day post-discharge physician follow-up in either the pre-COVID-19 or COVID-19 periods. In the COVID-19 period, functional decline was positively associated with 7-day virtual and home-visit follow-up.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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