Early Physician Follow-Up and Out-of-Hospital Outcomes After Cerebral Aneurysm Treatment in Elderly Patients

Abstract

Background The impact of early physician follow-up on out-of-hospital outcomes after cerebral aneurysm treatment has not been studied before. We investigated the association of early physician follow-up (within 30 days of discharge) with mortality and readmissions for elderly patients undergoing treatment for unruptured and ruptured cerebral aneurysms. Methods We performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent treatment for cerebral aneurysms from 2007 to 2012. In order to control for confounding, we used propensity score conditioning and inverse probability weighting, with mixed effects to account for clustering at the HRR level. Results Of the 8,703 patients presenting with unruptured aneurysms, 5,673 (65.2%) had early physician follow-up, and 3,030 (34.8%) did not. Of the 3,211 patients presenting with subarachnoid hemorrhage, 1,504 (46.8%) had early physician follow-up, and 1,707 (53.2%) did not. Propensity score adjusted analysis demonstrated that patients treated for unruptured aneurysms, who visited a physician within 30 days of discharge had lower 3-month mortality (OR, 0.52; 95% CI, 0.36 to 0.74), but a higher rate of 90-day readmissions (OR, 1.14; 95% CI, 1.03–1.28). Similarly, early follow-up was associated with lower 3-month mortality (OR, 0.33; 95% CI, 0.24 to 0.46), and a higher rate of 90-day readmissions (OR, 1.79; 95% CI, 1.02–3.14) for patients presenting with SAH. Conclusions In a cohort of Medicare patients undergoing treatment for cerebral aneurysms, we identified an association of early physician follow-up with decreased short-term post-discharge mortality, but increased 90-day readmissions. More studies on the impact of strengthening the post-discharge network on the outcomes of this population are warranted.

Primary Care Physician Follow-Up and 30-Day Readmission After Emergency General Surgery Admissions

“…9 While physicians have considerable control over the management and care of their patients during their admission, once patients leave the hospital there is limited monitoring and control to ensure a successful transition from inpatient to outpatient care. Although primary care physician (PCP) follow-up after discharge has been found to be associated with reduced readmission rates among patients hospitalized for medical conditions, such as pneumonia, heart failure, and chronic obstructive pulmonary disease, [10][11][12][13][14][15] less than half of Medicare beneficiaries readmitted within 30 days are seen by an outpatient PCP after discharge. 16 Additionally, 1 study found that early PCP follow-up after high-risk surgery was associated with a reduced risk of 30-day readmission among patients at higher risk for poor postoperative recovery.…”