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

Abstract

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