Individual factors associated with out-of-hours outpatient visits for emergency medical care and readmissions within 90 days of discharge among older adults: a retrospective cohort study

Aim: Transitional care interventions might help reduce the risk of emergency medical care and readmission after hospital discharge. However, it is unclear whether individual factors differentially affect the risks of these outcomes in Japan. We examined the individual factors associated with out-of-hours outpatient visits and readmissions among older Japanese adults. Methods: This retrospective cohort study analyzed residents of Kashiwa City who were discharged from hospital between 2012 and 2014. The outcomes were out-of-hours outpatient visits and readmissions within 90 days of discharge. The exposures were individual factors, such as age, sex, household income, certified care needs levels, diseases and health services before discharge. Fine–Gray proportional subdistribution hazards models were used to estimate the associations between the individual factors and outcomes. Results: Among 7842 patients, out-of-hours outpatient visits and readmissions occurred in 8.8% and 19.0% of patients, respectively. Patients with ischemic heart disease (subdistribution hazard ratio [SHR] 1.26, 95% confidence interval [CI] 1.06–1.48), dementia (SHR 1.29, 95% CI 1.04–1.61) and hearing impairment (SHR 1.49, 95% CI 1.07–2.07) were more likely to attend out-of-hours outpatient visits. In contrast, patients with other cardiac diseases (SHR 1.17, 95% CI 1.01–1.36), cancer (SHR 1.98, 95% CI 1.65–2.38), chronic obstructive pulmonary disease (SHR 1.26, 95% CI 1.04–1.52) and other lower respiratory tract diseases (SHR 1.16, 95% CI 1.04–1.31) were more likely to be readmitted. The use of discharge planning services was negatively associated with readmissions. Conclusion: Underlying factors for out-of-hours outpatient visits for emergency medical care and readmissions differed. The use of new follow-up methods and other targeted strategies are required in transitional care programs to address disease-specific needs.