Recent functional decline and outpatient follow-up after hospital discharge: A cohort study

Abstract

Abstract Background: Functional decline is common following acute hospitalization and is associated with hospital readmission, institutionalization, and mortality. Early physician follow-up has the potential to prevent poor outcomes and is integral to high-quality transitional care. Our study sought to determine whether functional decline was associated with post-discharge follow-up and whether this association changed following COVID-19, given that both functional decline and COVID-19 may affect access to post-discharge care. Method: We conducted a retrospective cohort study using health administrative data from Ontario, Canada. We included patients over 65 who were discharged from an acute care facility during March 1st, 2019 – January 31st, 2020 (pre-COVID-19 period), and March 1st, 2020 – January 31st, 2021 (COVID-19 period), and who were assessed for home care while in hospital. Patients with and without functional decline were compared. Our primary outcome was any physician follow-up visit within 7 days of discharge. Results: Our study included 21,771 (pre-COVID) and 17,248 (COVID) hospitalized patients, of whom 15,637 (71.8%) and 12,965 (75.2%) had recent functional decline. Our propensity-weighted cohorts included 15637/15810 patients with/without function decline in the pre-COVID-19 period and 12965/13132 with/without functional decline in the COVID-19 period. Pre-COVID, there was no difference in physician follow-up within 7 days of discharge (Exposed 45.0% vs Unexposed 44.0%; RR=1.02, 95% CI 0.98 – 1.06). These results did not change in the COVID-19 period (Exposed 51.1% vs. Unexposed 49.4%; RR=1.03, 95% CI 0.99-1.08, Z-test for interaction p=0.72). In the COVID-19 cohort, functional decline was associated with having a 7-day physician virtual visit (RR 1.15; 95% CI 1.08 – 1.24) and a 7-day physician home visit (RR 1.64; 95% CI 1.10 – 2.43). Conclusions: Functional decline was not associated with reduced 7-day post-discharge physician follow-up in either the pre-COVID-19 or COVID-19 periods. In the COVID-19 period, functional decline was positively associated with 7-day virtual and home-visit follow-up.