30-day healthcare utilisation after discharge from four General Internal Medicine departments in Switzerland: a prospective observational cohort study

To assess healthcare utilisation within 30 days of discharge, identify predictors of this utilisation, and examine its association with mortality. Adults discharged from four Swiss medicine departments were prospectively followed. The 30-day Healthcare Utilisation (HUTIL) index was calculated with consultations with primary care physicians (PCPs), specialists or at emergency departments (EDs), home visits by nurses and hospital readmissions and compared to the Swiss national values. The one-year age- and sex-adjusted risks of dying for each three-point increase in the HUTIL index were calculated using a Cox regression model. Of 934 patients included, 78% attended medical consultations, 25% received home-care nurse visits, 12% were readmitted to hospital and 9% consulted at an ED within 30 days of discharge. The median number of healthcare services used per patient (2; IQR 25–75%: 1–13) and HUTIL index scores (3.0; IQR 25–75%: 1.0–8.0) were significantly higher than Switzerland’s 30-day national values of 0.7 (p < 0.001) and 1.6 (p < 0.001), respectively. High HOSPITAL scores, age, hospital lengths of stay, and number of comorbidities were all associated with healthcare utilisation. Compared to patients with HUTIL index scores of 0–2.9, patients with scores of 3–5.9 (adjusted hazard ratio [aHR] 2.7; 95%CI: 1.1–6.7), 6–8.9 (aHR 5.5; 95%CI: 2.8–10.6), and more than 8.9 (aHR 9.6; 95%CI: 5.2–17.9), all had higher risks of dying within one year. Hospital discharge is followed by periods of high healthcare services utilisation. HUTIL index scores correlate with patients’ prognoses.