Timely Outpatient Follow-Up Reduces Hospital Readmissions

Adequate outpatient follow-up within 30 days significantly reduced the risk of 30-day all-cause hospital readmission, according to a new study published in JAMA Network Open.¹

Reducing excessive hospital readmissions within 30 days can have a substantial impact on hospital finances, lowering costs and improving patients' quality of care. For example, the Center for Medicaid and Medicare Services, under initiatives like the Hospital Readmission Reduction Program, penalizes hospitals for excessive 30-day readmissions for the same or related condition. These conditions include high-risk patients with heart failure (HF), acute myocardial infarction (AMI), pneumonia, chronic obstructive pulmonary disease (COPD), coronary artery bypass graft surgery (CABG), or elective primary total hip arthroplasty and/or total knee arthroplasty (THA/TKA).²

Overall, the mean cost of a single 30-day readmission episode is $16,037 (95% CI, USD 15,196.01–16,870.06); less than that of THA/TKA with a mean of $21,346.50 (95% CI, USD 20,818.14–21,871.85), but more than HF with a mean of $9817.42 and AMI with a mean of $6852.97.³ In this study researchers aimed to assess which patients would benefit the most from a timely follow-up to reduce hospital readmissions and lower costs.

Research Approach and Patient Follow-Up Process

Researchers scouted publication sites MEDLINE, Embase, and CINAHL for studies conducted between January 1, 2000, and August 4, 2025, using keywords associated with outpatient follow-up and hospital readmissions.¹ 

Of the 7653 studies identified, only 83 were included in the final analysis after they were screened for titles and abstracts. The studies included were published between 2010 and 2025. Of them, 69 (83.1%) were conducted in the US, and all of them had a sample size ranging from 65 to 749,402, including general inpatients or disease-specific admissions. Additionally, 4 studies (4.8%) assessed multiple disease groups, and 9 (10.8%) assessed multiple follow-up time intervals, resulting in 109 total assessments. Of the conditions penalized for excessive readmission, there were 22 patients assessed for HF, 9 patients with COPD, and 8 patients with AMI.

Readmission and Outpatient Follow-Up Rates

The all-cause readmission rates varied from 3.7% to 30.8% in general inpatients, 13.6% to 31.9% for patients with HF, 9.0% to 19.4% for patients with COPD, and 6.9% to 23.0% for patients with AMI. Overall, outpatient follow-up within 30 days was associated with a reduced risk of 30-day all-cause readmission (RRR, 0.68; 95% CI, 0.60-0.75) when compared with no follow-up.

Furthermore, the subgroup analysis adjusted by disease type, follow-up time, age, and sample risk rating showed a significant reduction in risk of readmission for HF and AMI (HF: RRR, 0.66 [95% CI, 0.55-0.78]; AMI: RRR, 0.64 [95% CI, 0.37-0.91]). In other diseases, such as pneumonia (RRR, 0.57; 95% CI, 0.53-0.61), researchers observed a similar reduction of risk in readmission; however, there were insufficient studies with low to moderate risk of bias.

Researchers observed that studies with a low to moderate risk of bias had the greatest reduction of risk of 30-day readmission, by 35% among those with HF patients and 44% in those with AMI. Yet there was only a slight reduction in readmissions for patients with strong associations and no association for patients with COPD or general inpatients.

The study was limited by the heterogeneity across study designs, populations, and follow-up, making comparisons difficult. Furthermore, the majority of data originated from US-based studies, thus limiting generalizability to other health systems. Lastly, potential misclassifications of diagnoses or age groups may have led to underestimating the benefits for high-risk patients.

“Rather than universal recommendations, risk factors such as patient age and disease should be considered in prioritizing post-discharge follow-up,” the authors concluded. “We emphasize the need for high-quality studies and offer actionable recommendations to guide future research.”

References

1. Balasubramania I, Andres EB, Malhotra C. Outpatient follow-up and 30-day readmissions: a systematic review and meta-analysis. JAMA Network Open. 2025;8(11):e2541272. doi:10.1001/jamanetworkopen.2025.41272

2. Hospital readmissions reduction program. CMS.gov. August 11, 2025. Accessed November 3, 2025. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp

3. Kum Ghabowen I, Epane JP, Shen JJ, Goodman X, Ramamonjiarivelo Z, Zengul FD. Systematic review and meta-analysis of the financial impact of 30-day readmissions for selected medical conditions: a focus on hospital quality performance. Healthcare. 2024 Mar 29;12(7):750. doi:10.3390/healthcare12070750