JAMA Netw Open. 2025 Nov 3;8(11):e2541272. doi: 10.1001/jamanetworkopen.2025.41272.
ABSTRACT
IMPORTANCE: Outpatient follow-up after discharge has been associated with reduced 30-day readmissions. Since universal follow-up is not feasible, identifying for whom and when outpatient follow-up is most beneficial is essential for optimizing resources and reducing readmissions.
OBJECTIVE: To quantify the association between outpatient follow-up within 30, 14, and 7 days postdischarge and 30-day all-cause readmissions and assess differences in outcomes by disease, age, and baseline readmission risk.
DATA SOURCES: MEDLINE (via PubMed), Embase, and CINAHL were searched for studies published between January 1, 2000, and August 4, 2025, using terms related to outpatient follow-up and readmissions.
STUDY SELECTION: English-language studies assessing the association between outpatient follow-up within 30 days of hospital discharge and 30-day all-cause readmissions among adult inpatients were included.
DATA EXTRACTION AND SYNTHESIS: Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, 2 reviewers independently screened titles and abstracts. Data were extracted by 1 author and verified by another, and quality assessment was done independently by 2 authors.
MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause 30-day readmission. Secondary outcomes included all-cause 30-day emergency department (ED) discharge and mortality. Pooled effect sizes (relative risk ratios [RRRs]) were estimated by disease and age group using multilevel random-effects models.
RESULTS: Eighty-three studies were included in the review and 76 in the meta-analysis. Outpatient follow-up within 30 days vs no follow-up was associated with a reduction in risk of 30-day all-cause readmission (RRR, 0.68; 95% CI, 0.60-0.75), with less reduction (RRR, 0.78; 95% CI, 0.67-0.89) when restricted to studies with low to moderate risk of bias (ROB). Among patients with heart failure (HF) and acute myocardial infarction (AMI), the RRRs for 30-day follow-up in studies with low to moderate ROB were 0.65 (95% CI, 0.48-0.83) and 0.56 (95% CI, 0.32-0.80), respectively. Subgroup analysis using studies with low to moderate ROB showed benefits of 30-day follow-up only among patients aged 65 years or older with HF (RRR, 0.65; 95% CI, 0.48-0.83), AMI (RRR, 0.56; 95% CI, 0.32-0.80), and other diseases such as stroke and chronic obstructive pulmonary disease (RRR, 0.73; 95% CI, 0.59-0.87). Early follow-up vs no follow-up within 14 and 7 days was associated with a significant reduction in readmissions only among patients aged 65 years or older with HF (14 days: RRR, 0.63 [95% CI, 0.40-0.87]; 7 days: RRR, 0.68 [95% CI, 0.47-0.89]) and AMI (14 days: RRR, 0.57 [95% CI, 0.22-0.91]; 7 days: RRR, 0.63 [95% CI, 0.34-0.92]).
CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, outpatient follow-up within 30 days was associated with reduced 30-day readmissions, but the association varied by patient age and disease type, indicating a need for targeted rather than universal follow-up.
PMID:41186947 | DOI:10.1001/jamanetworkopen.2025.41272
