Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort study
Abstract Purpose Patients with alcohol misuse are less likely to receive preventive health services but more likely to utilize emergency health services. However, the association between alcohol misuse and outpatient follow-up after hospitalization is unknown and may depend on whether a patient expe...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-12-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13722-018-0125-1 |
| _version_ | 1818446944299646976 |
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| author | Bryan Borg Ivor S. Douglas Madelyne Hull Angela Keniston Marc Moss Brendan J. Clark |
| author_facet | Bryan Borg Ivor S. Douglas Madelyne Hull Angela Keniston Marc Moss Brendan J. Clark |
| author_sort | Bryan Borg |
| collection | DOAJ |
| description | Abstract Purpose Patients with alcohol misuse are less likely to receive preventive health services but more likely to utilize emergency health services. However, the association between alcohol misuse and outpatient follow-up after hospitalization is unknown and may depend on whether a patient experiences a critical illness. We sought to determine whether alcohol misuse was associated with lower rates of outpatient follow-up after hospital discharge and whether the magnitude of this association differed in patients who experienced a critical illness. Materials and methods This was a retrospective cohort study using administrative data from an urban safety net hospital. Patients were included if they were admitted between 2011 and 2015, were between the ages of 18 and 89, resided within the safety net county, were discharged home, and were at moderate to high risk for hospital readmission within the subsequent 30 days. Alcohol misuse was identified using a combination of ICD-9 codes and response to a single screening question. The primary outcome was a combined measure of follow-up with a primary care physician or specialist provider in the 30 days following hospital discharge. Multivariable logistic regression was used to adjust for factors known to be associated with healthcare utilization. Results Overall, 17,575 patients were included in the analysis; 4984 (28%) had alcohol misuse. In the 30 days following hospital discharge, 46% of patients saw any outpatient provider. In an unadjusted analysis, the association between alcohol misuse and attending any outpatient follow-up was dependent on whether patients had a critical illness (p value < 0.0001) with the highest rates of follow-up in survivors of critical illness without alcohol misuse (53%, 95% CI 51%, 55%) followed by patients without alcohol misuse or critical illness (49%; 95% CI 48%, 50%), patients with alcohol misuse without critical illness (38%; 95% CI 36%, 39%), and patients with alcohol misuse and a critical illness (37%; 95% CI 35%, 40%). Adjusting for factors associated with healthcare utilization, these findings were modestly attenuated but unchanged. Conclusions Patients with alcohol misuse who are at moderate to high risk for hospital readmission may benefit from targeted interventions to increase rates of outpatient follow-up after hospital discharge. |
| first_indexed | 2024-12-14T19:55:46Z |
| format | Article |
| id | doaj.art-7d38c19d23704a3cb009ced444d66bf3 |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-12-14T19:55:46Z |
| publishDate | 2018-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-7d38c19d23704a3cb009ced444d66bf32022-12-21T22:49:18ZengBMCAddiction Science & Clinical Practice1940-06402018-12-0113111010.1186/s13722-018-0125-1Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort studyBryan Borg0Ivor S. Douglas1Madelyne Hull2Angela Keniston3Marc Moss4Brendan J. Clark5Department of Medicine, University of Colorado Anschutz Medical CampusDenver Health Medical CenterDenver Health Medical CenterDenver Health Medical CenterDivision of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical CampusDivision of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical CampusAbstract Purpose Patients with alcohol misuse are less likely to receive preventive health services but more likely to utilize emergency health services. However, the association between alcohol misuse and outpatient follow-up after hospitalization is unknown and may depend on whether a patient experiences a critical illness. We sought to determine whether alcohol misuse was associated with lower rates of outpatient follow-up after hospital discharge and whether the magnitude of this association differed in patients who experienced a critical illness. Materials and methods This was a retrospective cohort study using administrative data from an urban safety net hospital. Patients were included if they were admitted between 2011 and 2015, were between the ages of 18 and 89, resided within the safety net county, were discharged home, and were at moderate to high risk for hospital readmission within the subsequent 30 days. Alcohol misuse was identified using a combination of ICD-9 codes and response to a single screening question. The primary outcome was a combined measure of follow-up with a primary care physician or specialist provider in the 30 days following hospital discharge. Multivariable logistic regression was used to adjust for factors known to be associated with healthcare utilization. Results Overall, 17,575 patients were included in the analysis; 4984 (28%) had alcohol misuse. In the 30 days following hospital discharge, 46% of patients saw any outpatient provider. In an unadjusted analysis, the association between alcohol misuse and attending any outpatient follow-up was dependent on whether patients had a critical illness (p value < 0.0001) with the highest rates of follow-up in survivors of critical illness without alcohol misuse (53%, 95% CI 51%, 55%) followed by patients without alcohol misuse or critical illness (49%; 95% CI 48%, 50%), patients with alcohol misuse without critical illness (38%; 95% CI 36%, 39%), and patients with alcohol misuse and a critical illness (37%; 95% CI 35%, 40%). Adjusting for factors associated with healthcare utilization, these findings were modestly attenuated but unchanged. Conclusions Patients with alcohol misuse who are at moderate to high risk for hospital readmission may benefit from targeted interventions to increase rates of outpatient follow-up after hospital discharge.http://link.springer.com/article/10.1186/s13722-018-0125-1Alcohol abuseAlcoholismAlcohol use disorderAlcohol dependenceHospital readmissionHealthcare utilization |
| spellingShingle | Bryan Borg Ivor S. Douglas Madelyne Hull Angela Keniston Marc Moss Brendan J. Clark Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort study Addiction Science & Clinical Practice Alcohol abuse Alcoholism Alcohol use disorder Alcohol dependence Hospital readmission Healthcare utilization |
| title | Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort study |
| title_full | Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort study |
| title_fullStr | Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort study |
| title_full_unstemmed | Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort study |
| title_short | Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort study |
| title_sort | alcohol misuse and outpatient follow up after hospital discharge a retrospective cohort study |
| topic | Alcohol abuse Alcoholism Alcohol use disorder Alcohol dependence Hospital readmission Healthcare utilization |
| url | http://link.springer.com/article/10.1186/s13722-018-0125-1 |
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