The impact of timely community health services contact following hospital discharge on subsequent hospital use in England: retrospective observational study.

Abstract

Background: Unplanned rehospitalisation is an undesirable outcome for patients and resource-constrained health systems. Community health services (CHS) support safe transitions home and recovery following hospital discharge, but evidence on their effectiveness in reducing rehospitalisation is limited. This study examined the impact of timely contact with CHS teams following hospital discharge on the odds of subsequent emergency hospital care.

Methods: We used individual-level data from the Community Services Dataset on 63,019 individuals referred to 11 NHS Community Trust providers in England following hospital discharge between 1^st April and 31^st December 2019. Timeliness of CHS contact was defined as care being received within one day or between two and seven days post-discharge, compared to no contact within 30 days of discharge. Outcomes were emergency hospital readmission and emergency department (ED) attendance within 30 days of discharge. We used logistic regressions to estimate the association between timely CHS contact and hospital use, controlling for patient demographics, diagnosis and co-morbidities.

Results: Individuals in our sample were 72.5 years of age on average with 2.3 comorbidities, and 52% were female. 52% received care within one day of discharge, 20% within two to seven days, and 28% had no contact within 30 days. Having a CHS contact within one day of hospital discharge was associated with 33% lower odds of ED attendance (OR: 0.674, 95% CI: 0.640 to 0.709) and 38% lower odds of readmission within 30 days of discharge (OR: 0.615, 95% CI: 0.583 to 0.649), compared to individuals with no contact in the follow up period. Receiving a CHS contact between two to seven days of discharge was associated with 20% lower odds of ED attendance (OR: 0.804, 95% CI: 0.756 to 0.855) and 22% lower odds of readmission (OR: 0.775, 95% CI: 0.728 to 0.825) within 30 days of discharge.

Conclusions: Timely contact with CHS teams following discharge was associated with substantially lower odds of subsequent emergency hospital use. Whilst contact within two to seven days was beneficial for many patients, contact within one day of discharge was consistently associated with the largest reductions in hospital use across all patient groups.