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- Title
Redefining and redesigning hospital discharge to enhance patient care: a randomized controlled study.
- Authors
Balaban, Richard B.; Weissman, Joel S.; Samuel, Peter A.; Woolhandler, Stephanie
- Abstract
<bold>Background: </bold>Patients are routinely ill-prepared for the transition from hospital to home. Inadequate communication between Hospitalists and primary care providers can further compromise post-discharge care. Redesigning the discharge process may improve the continuity and the quality of patient care.<bold>Objectives: </bold>To evaluate a low-cost intervention designed to promptly reconnect patients to their "medical home" after hospital discharge.<bold>Design: </bold>Randomized controlled study. Intervention patients received a "user-friendly" Patient Discharge Form, and upon arrival at home, a telephone outreach from a nurse at their primary care site.<bold>Participants: </bold>A culturally and linguistically diverse group of patients admitted to a small community teaching hospital.<bold>Measurements: </bold>Four undesirable outcomes were measured after hospital discharge: (1) no outpatient follow-up within 21 days; (2) readmission within 31 days; (3) emergency department visit within 31 days; and (4) failure by the primary care provider to complete an outpatient workup recommended by the hospital doctors. Outcomes of the intervention group were compared to concurrent and historical controls.<bold>Results: </bold>Only 25.5% of intervention patients had 1 or more undesirable outcomes compared to 55.1% of the concurrent and 55.0% of the historical controls. Notably, only 14.9% of the intervention patients failed to follow-up within 21 days compared to 40.8% of the concurrent and 35.0% of the historical controls. Only 11.5% of recommended outpatient workups in the intervention group were incomplete versus 31.3% in the concurrent and 31.0% in the historical controls.<bold>Conclusions: </bold>A low-cost discharge-transfer intervention may improve the rates of outpatient follow-up and of completed workups after hospital discharge.
- Subjects
PATIENTS; PRIMARY care; HOSPITALS; RANDOMIZED controlled trials; OUTPATIENT medical care; MEDICAL quality control; LENGTH of stay in hospitals; RESEARCH; FERRANS &; Powers Quality of Life Index; TELEPHONES; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; CONTINUUM of care; PRIMARY health care; COMPARATIVE studies; CHI-squared test; COMMUNICATION; DISCHARGE planning
- Publication
JGIM: Journal of General Internal Medicine, 2008, Vol 23, Issue 8, p1228
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-008-0618-9