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Does increased access to primary care reduce hospital readmissions? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission.
N Engl J Med. 1996 May 30; 334(22):1441-7.NEJM

Abstract

BACKGROUND

For chronically ill patients, readmission to the hospital can be frequent and costly. We studied the effect of an intervention designed to increase access to primary care after discharge from the hospital, with the goals of reducing readmissions and emergency department visits and increasing patients' quality of life and satisfaction with care.

METHODS

In a multicenter randomized, controlled trial at nine Veterans Affairs Medical Centers, we randomly assigned 1396 veterans hospitalized with diabetes, chronic obstructive pulmonary disease, or congestive heart failure to receive either usual care or an intensive primary care intervention. The intervention involved close follow-up by a nurse and a primary care physician, beginning before discharge and continuing for the next six months.

RESULTS

The patients were severely ill. Half of those with congestive heart failure (504 patients) had disease in New York Heart Association class III or IV; 30 percent of those with diabetes (751 patients) had end-organ damage; and a quarter of those with chronic obstructive pulmonary disease (583 patients) required home oxygen treatment or oral corticosteroids. The patients had extremely poor quality-of-life scores. Although they received more intensive primary care than the controls, the patients in the intervention group had significantly higher rates of readmission (0.19 vs 0.14 per month, P = 0.005) and more days of rehospitalization (10.2 vs 8.8, P = 0.041). The patients in the intervention group were more satisfied with their care (P < 0.001), but there was no difference between the study groups in quality-of-life scores, which remained very low (P = 0.53).

CONCLUSIONS

For veterans discharged from Veterans Affairs hospitals, the primary care intervention we studied increased rather than decreased the rate of rehospitalization, although patients in the intervention group were more satisfied with their care.

Authors+Show Affiliations

Richard L. Roudebush Veterans Affairs Medical Center (VAMC), Indianapolis, IN 46202, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

8618584

Citation

Weinberger, M, et al. "Does Increased Access to Primary Care Reduce Hospital Readmissions? Veterans Affairs Cooperative Study Group On Primary Care and Hospital Readmission." The New England Journal of Medicine, vol. 334, no. 22, 1996, pp. 1441-7.
Weinberger M, Oddone EZ, Henderson WG. Does increased access to primary care reduce hospital readmissions? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission. N Engl J Med. 1996;334(22):1441-7.
Weinberger, M., Oddone, E. Z., & Henderson, W. G. (1996). Does increased access to primary care reduce hospital readmissions? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission. The New England Journal of Medicine, 334(22), 1441-7.
Weinberger M, Oddone EZ, Henderson WG. Does Increased Access to Primary Care Reduce Hospital Readmissions? Veterans Affairs Cooperative Study Group On Primary Care and Hospital Readmission. N Engl J Med. 1996 May 30;334(22):1441-7. PubMed PMID: 8618584.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does increased access to primary care reduce hospital readmissions? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission. AU - Weinberger,M, AU - Oddone,E Z, AU - Henderson,W G, PY - 1996/5/30/pubmed PY - 1996/5/30/medline PY - 1996/5/30/entrez SP - 1441 EP - 7 JF - The New England journal of medicine JO - N Engl J Med VL - 334 IS - 22 N2 - BACKGROUND: For chronically ill patients, readmission to the hospital can be frequent and costly. We studied the effect of an intervention designed to increase access to primary care after discharge from the hospital, with the goals of reducing readmissions and emergency department visits and increasing patients' quality of life and satisfaction with care. METHODS: In a multicenter randomized, controlled trial at nine Veterans Affairs Medical Centers, we randomly assigned 1396 veterans hospitalized with diabetes, chronic obstructive pulmonary disease, or congestive heart failure to receive either usual care or an intensive primary care intervention. The intervention involved close follow-up by a nurse and a primary care physician, beginning before discharge and continuing for the next six months. RESULTS: The patients were severely ill. Half of those with congestive heart failure (504 patients) had disease in New York Heart Association class III or IV; 30 percent of those with diabetes (751 patients) had end-organ damage; and a quarter of those with chronic obstructive pulmonary disease (583 patients) required home oxygen treatment or oral corticosteroids. The patients had extremely poor quality-of-life scores. Although they received more intensive primary care than the controls, the patients in the intervention group had significantly higher rates of readmission (0.19 vs 0.14 per month, P = 0.005) and more days of rehospitalization (10.2 vs 8.8, P = 0.041). The patients in the intervention group were more satisfied with their care (P < 0.001), but there was no difference between the study groups in quality-of-life scores, which remained very low (P = 0.53). CONCLUSIONS: For veterans discharged from Veterans Affairs hospitals, the primary care intervention we studied increased rather than decreased the rate of rehospitalization, although patients in the intervention group were more satisfied with their care. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/8618584/Does_increased_access_to_primary_care_reduce_hospital_readmissions_Veterans_Affairs_Cooperative_Study_Group_on_Primary_Care_and_Hospital_Readmission_ L2 - https://www.nejm.org/doi/10.1056/NEJM199605303342206?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -