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Introduction Home-hospital transitions are frequent among acutely ill older people, and may be reduced (fewer readmissions) by post-discharge secondary care (PDSC). We aimed to determine the proportion of older patients receiving PDSC after acute hospitalisation and compare outcomes with those not receiving PDSC.
Methods Retrospective observational study using electronic inpatient records. Participants were patients aged >75yrs who presented to a WDHB hospital emergency department (ED) and discharged from medical/surgical/geriatrics/orthopaedics wards in three 2-week periods (in September 2013, January 2014, May 2014). Proportional hazards models were used to assess associations of planning/attending PDSC with outcomes within 90-days of discharge.
Results Clinical records for 1085 patients (100% of above discharges) were searched. 965 patients were eligible (43 inpatient deaths, 23 discharge letter unavailable, 54 second/further admissions). Of all discharge summaries, 42.8% indicated planned PDSC (blinded validation of 100 randomly-selected records by a different investigator yielded a kappa of 0.85). Of those with planned PDSC, 30.5% had no appointment booked. 95% of surviving appointees attended PDSC. Patients with planned PDSC were no more likely to attend ED, vs. those without planned PDSC (Hazard ratio[HR] = 0.99, 95%CI = 0.81, 1.22; p = 0.94). However, patients actually attending PDSC were less likely to attend ED vs. those not attending (HR = 0.32, 95%CI = 0.24, 0.41; p < 0.0001). Patients attending PDSC had lower mortality, vs. those not attending (HR = 0.44, 95%CI = 0.28, 0.70; p = 0.0006). After excluding those discharged directly from hospital to long-term residential care (LTC), those attending PDSC were less likely to enter LTC vs. those not attending (HR = 0.26, 95%CI = 0.11, 0.63; p = 0.003).
Conclusions Older people discharged after acute hospitalisation are not receiving appropriate PDSC as they are not booked follow-up appointments despite discharge recommendations. Inappropriate PDSC planning and booking are strongly associated with undesirable outcomes, although not necessarily causal. Further research is planned to assess whether these undesirable outcomes are preventable through better discharge planning.