Impact of Transitional Care Management on 30-Day Readmissions
Author Information
Author(s): Kim Eun Ji, Coppa Kevin, Abrahams Sara, Hanchate Amresh D., Mohan Sumit, Lesser Martin, Hirsch Jamie S.
Primary Institution: Northwell Health
Hypothesis
Does the type of post-discharge follow-up visit affect 30-day readmission rates?
Conclusion
Transitional care management visits are associated with lower 30-day readmission rates compared to non-TCM visits.
Supporting Evidence
- TCM follow-up visits were associated with an 8.4% readmission rate compared to 13.9% for non-TCM visits.
- Being seen by a provider who frequently uses TCM visits reduced the odds of readmission.
- Patients with TCM visits had a hazard ratio of 0.46 for readmission compared to non-TCM visits.
Takeaway
Patients who have follow-up visits after leaving the hospital are less likely to return to the hospital within 30 days, especially if they have a special type of follow-up called transitional care management.
Methodology
A cross-sectional analysis using data from Northwell Health to compare 30-day readmission rates between patients with TCM and non-TCM follow-up visits.
Potential Biases
Potential underrepresentation of patients who had follow-up visits outside the health system.
Limitations
The health system database may not capture all out-of-network follow-up visits, and some patients may have been contacted within 48 hours without documentation.
Participant Demographics
Adult patients hospitalized to Medicine service, aged 21 and older.
Statistical Information
P-Value
<0.001
Confidence Interval
0.39–0.55
Statistical Significance
p<0.001
Digital Object Identifier (DOI)
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