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Does an Early Primary Care Follow-up after Discharge Reduce Readmissions for Heart Failure Patients?

Damien Bricard () and Zeynep Or ()

No DT73, Working Papers from IRDES institut for research and information in health economics

Abstract: Better monitoring of patients in primary care setting is often considered to be a solution for reducing avoidable hospitalisations and readmissions. In this paper we test the hypothesis that the risk of readmission is associated with the timing and intensity of primary care follow-up, with a focus on consultations with a generalist (GP) after discharge by patients hospitalized for heart failure in France. We propose a discrete-time model which takes into account that primary care treatments have a lagged and cumulative effect on readmission risk measured on a weekly basis, using an instrumental variable strategy (IV). The results from IV regressions suggest that a consultation with a GP in the first weeks after discharge can reduce the readmission risk by almost 50%, and that patients with higher ambulatory care utilisation have smaller odds of readmission. Furthermore, geographical disparities in primary care affect directly primary care utilization and hence indirectly the readmission risk. These results suggest that interventions which strengthen communication between hospitals and generalists are elemental for reducing readmissions and improving system-wide cost efficiency. In order to encourage better care transition and to improve patient outcomes after discharge, financial incentives for hospitals should be aligned with the objective of avoiding repeated hospitalisations. However, the current hospital funding system in France, based on patient volumes, does not provide any incentive for investments to improve patient follow-up after discharge.

Keywords: Hospital; Readmission; Heart failure; Primary care; Health care organisation; Instrumental variable; Discrete-time model. (search for similar items in EconPapers)
JEL-codes: C22 I12 L24 (search for similar items in EconPapers)
New Economics Papers: this item is included in nep-hea
Date: 2018-03, Revised 2018-03
References: View references in EconPapers View complete reference list from CitEc
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https://www.irdes.fr/english/working-papers/073-do ... failure-patients.pdf First version, 2018

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