A Third of Adults Discharged from a Hospital Don't See a Doctor Within 30 Days

Gaps in Care After Discharge Common for Adults Covered by All Types of Insurance

News Release
Dec. 8, 2011

Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON , DC—One in three adult patients—aged 21 and older—discharged from a hospital to the community does not see a physician within 30 days of discharge,accordingto a new national study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Even 90 days after discharge, 17.6 percent still had not seen a physician, nurse practitioner or physician assistant, the study found. Many adults who do not see a physician after discharge are at high risk of readmission because of chronic conditions or physical activity limitations, according to the study, which used 2000-08 data from the nationally representative Medical Expenditure Panel Survey (MEPS) to estimate the prevalence of hospital readmissions for all causes—other than obstetrical care—for adults aged 21 and older.

About one in 12 adults (8.2%) aged 21 and older discharged from a hospital to the community was readmitted within 30 days, according to the study, and one in three adults (32.9%) was rehospitalized within one year of discharge.

Reducing avoidable hospital readmissions is viewed as a way to improve quality and reduce unnecessary costs. While policy makers have targeted readmissions stemming from poor quality of care during an initial hospital stay, readmissions also can occur when patients don’t receive appropriate follow-up care or ongoing outpatient management of other conditions.

The study findings indicate that gaps in care after discharge are common for adults covered by all types of insurance. The lack of a usual source of care does not appear to be a barrier to receiving follow-up care, but many patients discharged from a hospital to home face challenges accessing their usual source of care.

“The implication is that reforms specific to one payer and focusing only on care processes within hospitals may fall short unless efforts to coordinate with community providers—and to encourage patients’ access to these providers—receive at least as much attention,” said HSC Senior Researcher Anna Sommers, Ph.D., coauthor of the study with Peter J. Cunningham, Ph.D., HSC director of quantitative research.

Strategies that could address gaps in care after discharge include bundled payments and patient-centered medical home efforts, which have potential to encourage hospitals and community-based clinicians to work together to lower rates of avoidable readmissions or rehospitalizations for other conditions. Moreover, investments in well-designed health information technology could help physician practices identify and monitor care for high-risk patients and foster information sharing between hospitals and community-based physicians.

The study’s findings are detailed in a new NIHCR Research Brief—Physician Visits After Hospital Discharge:  Implications for Reducing Readmissions—available online at www.nihcr.org.

Other key findings include:

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The National Institute for Health Care Reform contracts with the Washington, D.C.-based Center for Studying Health System Change to conduct high-quality, objective research and policy analyses of the organization, financing and delivery of health care in the United States. The nonpartisan, nonprofit 501 (c)(3)organization was created by the International Union, UAW; Chrysler Group LLC; Ford Motor Company; and General Motors to help inform policy makers and other decision-makers about options to expand access to high-quality, affordable health care to all Americans.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.