An electronic health record-based intervention to increase follow-up office visits and decrease rehospitalization in older adults

Abstract

Objectives: To assess the effect of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital.

Design: Randomized controlled trial.

Setting: Large multispecialty group practice.

Participants: Individuals aged 65 and older discharged from hospital to home.

Intervention: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule a posthospitalization office visit.

Measurements: An outpatient office visit with a primary care provider after discharge and rehospitalization within 30 days after discharge.

Results: Of the 1,870 discharges in the intervention group, 27.7% had an office visit with a primary care provider within 7 days of discharge. Of the 1,791 discharges in the control group, 28.3% had an office visit with a primary care provider within 7 days of discharge. In the intervention group, 18.8% experienced a rehospitalization within the 30-day period after discharge, compared with 19.9% in the control group. The hazard ratio for an office visit with a primary care physician did not significantly differ between the intervention and control groups. The hazard ratio for rehospitalization in the 30-day period after hospital discharge in the intervention versus the control group was 0.94 (95% confidence interval = 0.81-1.1).

Conclusion: This electronic health record-based intervention did not have a significant effect on the timeliness of office visits to primary care providers after hospitalization or risk of rehospitalization.

Keywords: care transitions; randomized controlled trial; readmission; rehospitalization; safety.

Figure 1. Adapted CONSORT Flow Diagram

Figure 2

Kaplan-Meier estimates of time to an office visit with a primary care physician.

Figure 3

Kaplan-Meier estimates of time to rehospitalization.