NYMC Student Theses and Dissertations

Date of Award

12-3-2019

Document Type

Doctoral Dissertation - Open Access

Degree Name

Doctor of Public Health

Department

Public Health

First Advisor

Adam Block, PhD

Second Advisor

Patricia Patrick, PhD

Third Advisor

Kenneth Knapp, PhD

Abstract

Post-Hospitalization Primary Care Follow-Up Abstract

Title: Characteristics that are associated with primary care follow-up and discharge summary receipt post-hospitalization in adults with intellectual and/or developmental disabilities.

Background: Transition from an inpatient to an outpatient setting is a high risk time for patients. Studies in the general population find that poor post-hospitalization primary care follow-up results in higher rates of readmissions – a widely used indicator of healthcare quality. There is no research that evaluates post-hospitalization primary care follow-up or discharge summary receipt in the IDD population.

Objective: To explore the demographic, socioeconomic, and clinical characteristics that are associated with whether an adult with IDD will achieve timely post-hospitalization primary care follow-up.

Methods: A cross-sectional study evaluating 788 hospitalizations of adults with IDD from January 1, 2012 to December 31, 2016 and their primary care follow-up at an IDD-specific multi-specialty outpatient facility. Applicable inpatient admissions were identified using Medicare Quality and Resource Use Reports and linked to the outpatient facilities’ electronic medical records in order to capture demographic, socioeconomic, clinical, and follow-up variables on each subject.

Results: A total of 788 hospital admissions completed by 341 unique individuals were identified. This population had a high rate of primary care follow-up (94.8%), and hospitalization discharge summary receipt (83.5%) within 30 days. Multivariate regression analysis, which controlled for demographics, living situation, level of intellectual disability, hospital, and principal hospital diagnosis, identified that living in non-group home settings was associated with a lower likelihood of timely primary care follow-up and discharge summary receipt when compared to adults with IDD who live in group homes. This analysis also detected that age over 40 was associated with a lower likelihood or primary care follow-up within 7 days (aOR: 0.2, 95% CI: 0.1-0.8) and non-Caucasian race to be associated with a higher likelihood of primary care follow-up within 14 days (aOR: 2.3, 95% CI: 1.0-5.3).

Conclusion: The major variable that predicted timely primary care follow-up and discharge summary receipt was living in a group home. This is most likely due to state-mandated audits of group home policies and procedures. Nevertheless, primary care follow-up for the population evaluated in this study was much better than the general Medicare population. Primary care providers and hospital discharge teams should be cognizant of the challenges and barriers that adults with IDD who live in non-group home settings face. Further research should continue to evaluate the success that group homes have had in post-hospitalization primary care follow-up and communicate their success to other state regulatory groups.

Available for download on Tuesday, September 01, 2020

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