An outpatient critical care transition clinic model reduces admissions/readmissions in medically complex patients.

Abstract

OBJECTIVES\nReducing hospital admissions in patients with multiple complex chronic conditions is both a quality indicator and cost-effective to health care systems. This study assesses and compares utilization rates and cost of encounters between patients referred and seen in an outpatient critical care transition clinic (Healthy Transitions Clinic [HTC]) and those referred and not seen.\n\n\nSTUDY DESIGN\nRetrospective cohorts.\n\n\nMETHODS\nPatients with complex chronic conditions discharged from a tertiary/quaternary acute care hospital or emergency department (March 1, 2015, to February 29, 2016) were referred to an outpatient critical care transition clinic. Comparative cohorts were those patients who attended this transition clinic and those who did not. Pre- and post-HTC referral visits, with health care utilization evaluations including admissions/readmissions, attention to social determinants of health, and cost assessments, were compared among the cohorts.\n\n\nRESULTS\nInsurance coverage differed significantly in its distribution between the groups (χ2\u2009=\u200922.99; P\u2009<\u2009.001); therefore, an adjusted relative risk model was used. Inpatient admissions significantly increased, by 31%, in the non-HTC cohort (P\u2009=\u2009.03); a significant increase in the rate of 30-day readmissions (69%) occurred in the HTC group (P\u2009<\u2009.001) at 6 months post index admission. Length of stay did not differ pre- and post HTC visit. Although not statistically significant, visits to the HTC reduced median all-cost and HTC cohort cost by more than $1 million.\n\n\nCONCLUSIONS\nIn patients with complex chronic medical conditions with recent hospital admissions, the HTC model appears to reduce both admissions and encounter costs. Further community/regional studies are needed to better define this observation on a longitudinal basis.