• James M Gill, Arch G Mainous, and Musa Nsereko.
• Department of Family and Community Medicine, Christiana Care Health System, Newark, Delaware, USA.
• Del Med J. 2003 Aug 1;75(8):291-8.

ObjectiveTo determine whether or not having an outpatient visit after hospital discharge is associated with a lower likelihood of readmission for a statewide Medicaid population.Design And SettingA case-control study in the Delaware Medicaid program over a two-year period (7/1/93-6/30/95).Participants3,846 continuously enrolled patients aged 0-64 years who were hospitalized and were readmitted within 90 days (cases = 641) or not readmitted within 90 days (controls = 3,205). Subgroups included those readmitted for the same diagnosis (N = 720), for ambulatory care sensitive conditions (N = 906), or both (N = 276).Main Outcome MeasureLikelihood of readmission within 90 days of discharge.ResultsReadmission was significantly more likely when an outpatient visit was made after hospital discharge, both before and after controlling for demographic variables and case mix (adjusted odds ratio = 1.47, 95% confidence interval = 1.20-1.80). When readmission for the same diagnosis was examined, having an outpatient visit was associated with an increased likelihood of readmission before but not after controlling for demographics and case mix (adjusted odds ratio = 1.11, 95% confidence interval = 0.67-1.86). The same was for those admitted for ambulatory care sensitive conditions (adjusted odds ratio = 1.16, 95% confidence interval = 0.74-1.85) and for those readmitted for the same ambulatory care sensitive condition (adjusted odds ratio = 1.53, 95% confidence interval = 0.54-4.29).ConclusionsThis study fails to demonstrate that outpatient visits after hospital discharge are associated with fewer readmissions for nonelderly Medicaid patients. This suggests that it may not be appropriate to use hospital readmission rates as an indicator of the quality of outpatient care.

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