Healthcare costs have risen from consuming 13.8% of the gross domestic product in 2000 to consuming 17.9% of the gross domestic product in 2009 (Gordon, Leiman, Deland, & Pardes, 2014). Poor transitional care has been identified as a cause of the high healthcare costs (Naylor et al., 2013; Obama, 2013). In 2009, the Department of Veterans Health Administration (VHA) implemented a national reform of outpatient care to create Patient-Aligned Care Teams (PACTs) with a goal to improve transitional care and reintegration into outpatient care through registered nurse case managers conducting discharge telephone follow-up calls. However, there is conflicting evidence regarding the effectiveness of discharge telephone follow-up calls, and the effectiveness of discharge follow-up calls has not been explored within the VHA.
This study explored the relationships among receipts of discharge telephone follow-up calls, selected Veteran characteristics including the length of index hospital stay, and 30-day all cause hospital readmissions from fiscal years 2011 and 2013. Hospital readmissions were explored by three clinically relevant time periods based off the recommended timing of discharge telephone follow-up calls (within two days of discharge, between three and seven days of discharge, between eight and thirty days of discharge). Study data were collected retrospectively from VHA inpatient and outpatient records. Descriptive statistics, measures of central tendency, bivariate statistics, and logistic regression were used to analyze the data.
Data from this study show that 124,069 Veterans were discharged from the VHA from 2011 to 2013. Of those discharges, 15,954 (12.86%) were readmitted to the hospital within 30 days, with 35.06% of readmissions occurring within the first seven days of discharge. Discharge telephone follow-up calls increased from 312 in 2011 to 26,549 in 2013. Increasing Veteran age, number of comorbidities, length of index hospital stay, and being identified as frequently hospitalized in the previous year were significantly related to hospital readmissions at each of three hospital readmission time frames (within two days, between three and seven days, and between eight and thirty days after hospital discharge).
Receipt of discharge telephone follow-up calls was associated with a lower likelihood of hospital readmission, but was limited to receipt of discharge telephone follow-up calls within two days and a decreased likelihood of hospital readmissions within two days after discharge (OR=0.595). There are two explanations for why the relationship between discharge telephone follow-up calls and hospital readmissions was limited to follow-up within two days and readmissions within two days of discharge: Discharge telephone follow-up calls within two days of discharge may have a short, protective effect. However, the second explanation is that self-selection bias confounds the relationship between discharge telephone follow-up calls and hospital readmissions (i.e., those who do not receive the calls are those who are readmitted). This time-limited relationship could explain previously mixed results related to the effectiveness of follow-up calls on 30 days hospital readmissions. Both explanations suggest future research and clinical practice should focus on exploring more intensive transitional care interventions, particularly at the period immediately after discharge, as a method to reduce hospital readmissions.