Health Services/Policy
Follow-up visits with a physician after discharge from hospital: a retrospective cohort study Derek Manis* Derek Manis Chantal Backman Colleen Webber Stacey Fisher Wenshan Li Jennifer Watt Peter Tanuseputro Nathan Stall David Kirkwood Andrew Costa
Background: Older adult (65 years and older) residents of assisted living (AL) and community-dwelling home care (HC) recipients have high rates of hospital-based care, yet substantially low rates of primary care and specialist physician visits. The disproportionate use of these services has important implications for single-payer, publicly funded health care systems.
Objective: To examine the 30-day risk of a follow-up visit with a physician after discharge from hospital among residents of AL and HC recipients.
Design, Setting, and Participants: Retrospective cohort study using linked, population-level health system administrative databases and reliable and valid chronic conditions algorithms in Ontario, Canada from July 1, 2018 to June 30, 2023.
Methods: The outcome of interest was an outpatient visit with a primary care or specialist physician within 30 days of hospital discharge. Clinical, community, and health service use variables were obtained. Inverse probability (IP) weighted discrete-time hazards were used to model standardized cumulative incidence curves. From these curves, the 30-day risk of a follow-up visit with a physician was derived.
Results: This study included 3,144 residents of AL (mean [SD] age 88 [6.4] years, 72% female) and 26,046 HC recipients (mean [SD] age 84 [7.4] years, 60% female). The mean of the IP weights was 1.1. The 30-day risk of a follow-up visit was 0.999 and 0.998 among residents of AL and HC recipients, respectively (RD 0.001; RR 1.000).
Conclusions and Implications: These findings demonstrate that older adults receive care from a physician in their community following discharge from hospital, despite narratives suggesting inadequate access. The IP weights mostly balanced the confounders in each population, but underlying differences related to unpaid caregiving and household income, both of which are not available in these health system data, may be important factors to inform future data collection for health system planning.