LAUSR

In a resource limited setting such as the Philippines determining which patients are at high risk for readmission and the factors affecting their ability to adhere to post-hospitalization outpatient consult are key to ensuring efficient and safe healthcare delivery. This was a prospective cohort study including patients of the General Medicine service in the Philippine General Hospital. Patient demographics, hospitalization details, and HOSPITAL score were collected prior to discharge. Succeeding patient encounters were classified as readmission, outpatient consult and lost to follow-up; data was collected using a researcher-guided questionnaire. Patients lost to follow up 30 days from discharge were traced. Factors associated with readmission and adherence to post hospitalization consult were extracted; readmission rate, outpatient follow up rate and time to follow up were summarized. Of the 619 patients included, outpatient follow up rate was 36.3% with a time to follow up of 15.6 +/- 6.8 days. Readmission rate was 16% with time to readmission of 12.4 +/- 7.8 days. Strongest risk factors for readmission were HOSPITAL score of High [RR 2.94 (2.09-4.13)] and prior admission in the last 30 days [RR 2.53 (1.71-3.74)]. Lastly, lost to follow up rate was 47%, and the most frequent reasons preventing outpatient consult were related to health condition (37.3%) and socioeconomic reasons (31.2%). Patients identified as high risk for readmission and had recent admission had an increased risk of further readmission. Half of patients discharged were eventually lost to follow up, most commonly due to worsening health conditions and socioeconomic limitations, while majority of the patients who were able to follow up were deemed of low to intermediate risk of readmission. These findings highlight the importance of risk stratifying patients prior to discharge and identifying potential factors to improve outcomes at an institutional level. In a resource limited setting stratifying patient’s risk for preventable readmission and targeting identified risk factors are key to reduce negative patient outcomes and unnecessary health spending. The current health condition and socioeconomic factors strongly affect the patient’s ability to adhere to prescribed post-hospitalization outpatient consult.