Impact of ‘Clinic First’ Model on 30-day Hospital Readmission Rates in a Family Medicine Residency

Background and Hypothesis: In 2019, the Association of American Medical Colleges (AAMC) released a collaborative design initiated by four family medicine residency programs called “Clinic First'' model (CFM). This model of residency training employs 2-week intermittent blocks of continuity clinics and clinical rotations, allowing more immersive participation in both.
This study explores implementing the CFM at our residency program and its impact on 30-day hospital readmission rates and compliance with discharge follow-up appointments. We hypothesized that heightened focus on outpatient care would result in reduced rehospitalization rates.

Methods: Our research was designed as a two part prospective cohort study. The setting was established at SIU Quincy Family Practice (QFP) and Blessing Hospital which included faculty, medical residents and nursing staff. Thirty-day hospital readmission rates were provided by the Blessing Hospital Chief Quality and Safety Officer via the Blessing Electronic Health Record (EHR). Outpatient EHR was evaluated to confirm the patient was seen for hospital follow-up in the clinic within 1 week, but up to 30 days post-discharge. Hospital readmission rates were compared pre and post CFM implementation. Inclusion criteria included hospitalized SIU established patients or patients establishing care at SIU. Patients from nursing homes, obstetrics, rehabilitation, SIU-affiliated satellite clinic, and those who left AMA were excluded. Our control group included the patient populations prior to CFM implementation. Total number of discharges included 920 with 578 in control group and 342 in study group. Our primary outcome was 30-day hospital readmission rates.

Results: Our raw data, two months prior to CFM, was 9 thirty-day readmissions out of 156 unique hospital visits and 6 out of 135. Two months after initiation of CFM, readmission data was 4 out of 162 and 4 out of 180. The same months of the previous year showed 6 out of 142 and 6 out of 145.
Our 2 month hospital 30-day readmission rates, prior to CFM averaged 5.1%. Readmission rates after initiation of CFM, for two months, averaged 2.4%. Hospital readmission rates comparing the data, of 2021 pre Clinic First model vs. 2022 post CFM, revealed an average of 4.2% vs. 2.4% Further results can be delineated as additional data is gathered through 2023.

Conclusion: Although the effect of implementing the CFM is in the preliminary stages of development, we anticipate that this intervention will decrease hospitalization readmission rates. Our exploratory data trend toward a decrease in hospital readmission rates when we compare pre and post Clinic First models. The new model allowed for succinct transition of care between inpatient and outpatient providers. A meta-analysis showed a reduction in all-cause hospitalization for high-risk chronic conditions and all-cause mortality with the addition of post-discharge interventions. The cost of hospital readmissions bear a considerable burden to the healthcare system. Furthermore, hospitals face reduced reimbursement based on higher rates of readmission. With the caveat of limited data, CFM contributes to improved osteopathic patient care, enhanced patient safety, and a cost effective healthcare delivery system.

Acknowledgement of Research Study Sponsors and IRB: It was deemed by SIU Family Medicine Department Research Committee that this study was exempt from IRB approval.