Associations Between Early Physician Follow-up and Post-discharge Outcomes: A Systematic Review and Meta-analysis

Abstract

Background: Early physician follow-up after hospital discharge is commonly recommended, though whether it mitigates adverse events is unclear. We conducted a systematic review and meta-analysis to examine the association between physician follow-up within 30 days of hospital discharge and risk of hospital readmission, emergency department (ED) visits, or mortality in medical patients.

Methods: MEDLINE, EMBASE, and CINAHL electronic databases were searched from inception to April 2023. Inclusion criteria were original studies that reported association(s) between outpatient physician visit within 30 days of hospital discharge and at least one outcome of interest (emergency department visit, readmission, or mortality) for adult medical patients. Two investigators independently completed screening, extracted data, and assessed study quality using an adapted Down's and Black tool. Meta-analyses were conducted for each outcome using random effects models.

Results: Sixty-six studies were included in the review. Early physician follow-up was significantly associated with reduced odds of hospital readmission (pooled OR 0.69 [95% CI 0.58, 0.81], n=54) and mortality (pooled OR 0.71 [95% CI 0.55, 0.90], n=21) but not emergency department visits (pooled OR 0.77 [95% CI 0.59, 1.01], n=10). A majority of studies were at high risk of selection bias or residual confounding or both. When pooling only studies at low risk of bias in these domains or when only pooling randomized controlled trials, associations between early physician follow-up and 30-day readmission were not statistically significant (pooled OR 1.01 [95% CI 0.93, 1.09], n=11; and 1.07 [95% CI 0.85, 1.36], n=5; respectively).

Discussion: While meta-analysis suggests that early physician follow-up may be associated with reduced readmissions and mortality, there is a need to interpret these results with caution given that a majority of included studies were observational in nature and were at high risk of bias. It therefore remains unclear whether early physician follow-up is effective in reducing post-discharge adverse events of readmission, emergency department visits, and mortality.

Registration: PROSPERO CRD42022334467.

Keywords: hospital readmission; physician follow-up; systematic review.