Posthospitalization telemedicine follow-up and 30-day readmission across the COVID-19 era: A multiphase analysis in a large integrated healthcare system.

Abstract

Background: Timely postdischarge visits reduce readmissions, but the impact of telemedicine follow-up remains unclear. The coronavirus disease 2019 (COVID-19) pandemic rapidly expanded telemedicine, offering a unique opportunity to assess its impact on outcomes.

Objectives: Evaluate the association between telemedicine versus in-person follow-up and 30-day outcomes before, during, and after the COVID-19 pandemic.

Methods: Retrospective cohort study of adults discharged from the Medicine Service across 21 hospitals (2017-2023). Telemedicine (video/telephone) versus in-person visits within 7 days of discharge were compared. The primary outcome was 30-day nonelective readmission. Secondary outcomes included 30-day all-cause readmission, emergency department (ED) visits, and mortality. Competing risk and Cox regression models were used, with inverse probability of treatment weighting to address differences.

Results: Among 137,765 patients (mean age 67.5 years, 49.1% female), 59.2% received telemedicine follow-up. Pre-pandemic, 28.2% had telemedicine visits, associated with higher 30-day nonelective readmission risk (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI]: 1.19-1.28, p < .01) and mortality (aHR: 1.87, 95% CI: 1.71-2.05, p < .01). During COVID-19, telemedicine was associated with lower nonelective readmission risk (aHR: 0.92, 95% CI: 0.88-0.97, p < .01), fewer ED visits (aHR: 0.88, 95% CI: 0.84-0.92, p < .01), and no difference in mortality (aHR: 1.10, 95% CI: 0.98-1.24, p = .11). Post-COVID-19, readmission and ED visit risks were similar, though mortality was higher in the telemedicine group (aHR: 1.33, 95% CI: 1.20-1.49, p < .01).

Conclusions: Telemedicine follow-up was associated with favorable outcomes during the pandemic, supporting its use as an alternative to in-person care. Pre- and postpandemic differences likely reflect patient selection. A hybrid follow-up model may optimize access and outcomes in postdischarge care.