General practitioners' home visit tendency and readmission-free survival after COPD hospitalisation: a Danish nationwide cohort study

Abstract

Background: The tendency of general practitioners (GPs) to conduct home visits is considered an important aspect of practices' accessibility and quality of care.

Aims: To investigate whether GPs' tendency to conduct home visits affects 30-day readmission or death after hospitalisation with chronic obstructive pulmonary disease.

Methods: All Danish patients first-time hospitalised with COPD during the years 2006-2008 were identified. The association between the GP's tendency to conduct home visits and the time from hospital discharge until death or all-cause readmission was analysed by means of Cox regression adjusted for multiple patient and practice characteristics.

Results: The study included 14,425 patients listed with 1,389 general practices. Approximately 31% of the patients received a home visit during the year preceding their first COPD hospitalisation, and within 30 days after discharge 19% had been readmitted and 1.6% had died without readmission. A U-shaped dose-response relationship was found between GP home visit tendency and readmission-free survival. The lowest adjusted risk of readmission or death was recorded among patients who were listed with a general practice in which >20-30% of other listed first-time COPD-hospitalised patients had received a home visit. The risk was higher if either 0% (hazard rate ratio 1.18 (1.01-1.37)) or >60% (hazard rate ratio 1.23 (1.04-1.44)) of the patients had been visited.

Conclusion: A moderate GP tendency to conduct home visits is associated with the lowest 30-day risk of COPD readmission or death. A GP's tendency to conduct home visits should not be used as a unidirectional indicator of the ability to prevent COPD hospital readmissions.

Figure 1

Flowchart.

Figure 2

The x axis shows the general practice home visit tendency, that is, the proportion of other first-time COPD-hospitalised patients listed with the patient’s practice who had a home visit in the year before hospitalisation. The bars show the distribution of all first-time COPD-hospitalised patients according to their practice’s home visit tendency. The dots show adjusted hazard rate ratios (HRs) compared with the reference group of patients whose practice had a home visit tendency of >20–30%. Vertical lines show 95% confidence intervals for the HRs.

Figure 3

Kaplan–Meier curves of first-time COPD-hospitalised patients’ readmission-free survival according to the practice’s home visit tendency. Readmission-free survival is poorer, the more general practitioner home visit tendency (GPHVT) is either lower (left) or higher (right) compared with >20–30% of patients receiving a home visit.