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Previous Volume 334:1441-1447 May 30, 1996 Number 22 Next

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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.

Source Information

From the Richard L. Roudebush Veterans Affairs Medical Center (VAMC), Indianapolis (M.W.); the Center for Health Services Research in Primary Care, Durham VAMC, Durham, N.C. (E.Z.O.); and the Center for Cooperative Studies in Health Services, Hines VAMC, Hines, Ill. (W.G.H.).

Address reprint requests to Dr. Weinberger at Health Services Research and Development (11H), Richard L. Roudebush VAMC, 1481 W. Tenth St., Indianapolis, IN 46202.

Full Text of this Article

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A Trial of Increased Access to Primary Care
Henley D. E., Starfield B., Parrino T. A., Snider G. L., Colucci W. S., Sawin C. T., Magill M. K., Babitz M., Silver M. P., Rich M. W., Corey G. A., Burack J. H., Portnoi V. A., Adams W. L., Weinberger M., Oddone E. Z., Henderson W. G., Welch H. G.
Extract | Full Text  
N Engl J Med 1996; 335:895-898, Sep 19, 1996. Correspondence

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