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

Rumiko Tsuchiya-Ito; Seigo Mitsutake; Chie Teramoto; Shota Hamada; Satoru Yoshie; Nanako Tamiya; Katsuya Iijima; Tatsuro Ishizaki

doi:10.1111/ggi.70051

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

Geriatr Gerontol Int. 2025 Jun;25(6):789-798. doi: 10.1111/ggi.70051. Epub 2025 May 7.

Authors

Rumiko Tsuchiya-Ito^{1

2

3}, Seigo Mitsutake^{1

4}, Chie Teramoto⁵, Shota Hamada^{3

6

7}, Satoru Yoshie^{8

9

10

11

12}, Nanako Tamiya^{6

8}, Katsuya Iijima^{10

11}, Tatsuro Ishizaki¹

Affiliations

¹ Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
² Research Department, Dia Foundation for Research on Ageing Societies, Tokyo, Japan.
³ Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.
⁴ Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
⁵ Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁶ Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
⁷ Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁸ Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan.
⁹ Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.
¹⁰ Institute of Gerontology, The University of Tokyo, Tokyo, Japan.
¹¹ Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan.
¹² School of Medicine, Hiroshima University, Hiroshima, Japan.

PMID: 40329673
DOI: 10.1111/ggi.70051

Abstract

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. Geriatr Gerontol Int 2025; 25: 789-798.

Keywords: chronic diseases; discharge planning; emergency medicine; older people; transitional care.

MeSH terms

After-Hours Care* / statistics & numerical data
Aged
Aged, 80 and over
Ambulatory Care* / statistics & numerical data
Emergency Medical Services* / statistics & numerical data
Female
Humans
Japan / epidemiology
Male
Patient Discharge* / statistics & numerical data
Patient Readmission* / statistics & numerical data
Retrospective Studies
Risk Factors

Abstract

MeSH terms

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