Association between clinic physician workforce and avoidable readmission: a retrospective database research

BACKGROUND: To reduce hospitalization costs, it is necessary to prevent avoidable hospitalization as well as avoidable readmission. This study aimed to examine the relationship between clinic physician workforce and unplanned readmission for ambulatory care sensitive conditions (ACSCs). METHODS: The present study was a retrospective database research using nationwide administrative claims database of acute care hospitals in Japan. We identified patients aged ≥65 years who were admitted with ACSCs from home and discharged to home between April 2014 and December 2014 (n = 127,209). The primary outcome was unplanned readmission for ACSCs within 30 or 90 days of hospital discharge. A hierarchical logistic regression model was developed with patients at the first level and regions (secondary medical service areas) at the second level. RESULTS: The 30-day and 90-day ACSC-related readmission rates were 3.7 and 4.6%, respectively. The high full-time equivalents (FTEs) of clinic physicians per 100,000 population were significantly associated with decreased odds ratios for 30-day and 90-day ACSC-related readmissions. This association did not change even when sensitivity analyses was conducted. CONCLUSIONS: Among patients who had history of admission for ACSCs, greater clinic physician workforce prevented the incidence of readmission because of ACSCs. Regional medical plans to prevent avoidable readmissions should incorporate policy interventions that focus on the clinic physician workforce.