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

BACKGROUND: Functional 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...

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Autores principales: Bogler, Orly, Kirkwood, David, Austin, Peter C., Jones, Aaron, Sinn, Chi-Ling Joanna, Okrainec, Karen, Costa, Andrew, Lapointe-Shaw, Lauren
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496187/
https://www.ncbi.nlm.nih.gov/pubmed/37697250
http://dx.doi.org/10.1186/s12877-023-04192-7
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author Bogler, Orly
Kirkwood, David
Austin, Peter C.
Jones, Aaron
Sinn, Chi-Ling Joanna
Okrainec, Karen
Costa, Andrew
Lapointe-Shaw, Lauren
author_facet Bogler, Orly
Kirkwood, David
Austin, Peter C.
Jones, Aaron
Sinn, Chi-Ling Joanna
Okrainec, Karen
Costa, Andrew
Lapointe-Shaw, Lauren
author_sort Bogler, Orly
collection PubMed
description BACKGROUND: Functional 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. METHOD: We 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. RESULTS: Our 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). CONCLUSIONS: Functional 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-04192-7.
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spelling pubmed-104961872023-09-13 Recent functional decline and outpatient follow-up after hospital discharge: a cohort study Bogler, Orly Kirkwood, David Austin, Peter C. Jones, Aaron Sinn, Chi-Ling Joanna Okrainec, Karen Costa, Andrew Lapointe-Shaw, Lauren BMC Geriatr Research BACKGROUND: Functional 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. METHOD: We 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. RESULTS: Our 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). CONCLUSIONS: Functional 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-04192-7. BioMed Central 2023-09-11 /pmc/articles/PMC10496187/ /pubmed/37697250 http://dx.doi.org/10.1186/s12877-023-04192-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Bogler, Orly
Kirkwood, David
Austin, Peter C.
Jones, Aaron
Sinn, Chi-Ling Joanna
Okrainec, Karen
Costa, Andrew
Lapointe-Shaw, Lauren
Recent functional decline and outpatient follow-up after hospital discharge: a cohort study
title Recent functional decline and outpatient follow-up after hospital discharge: a cohort study
title_full Recent functional decline and outpatient follow-up after hospital discharge: a cohort study
title_fullStr Recent functional decline and outpatient follow-up after hospital discharge: a cohort study
title_full_unstemmed Recent functional decline and outpatient follow-up after hospital discharge: a cohort study
title_short Recent functional decline and outpatient follow-up after hospital discharge: a cohort study
title_sort recent functional decline and outpatient follow-up after hospital discharge: a cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496187/
https://www.ncbi.nlm.nih.gov/pubmed/37697250
http://dx.doi.org/10.1186/s12877-023-04192-7
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