0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Quality of Discharge Practices and Patient Understanding at an Academic Medical Center

Leora I. Horwitz, MD, MHS1,2; John P. Moriarty, MD1; Christine Chen, MD3; Robert L. Fogerty, MD, MPH1; Ursula C. Brewster, MD4; Sandhya Kanade, MD3; Boback Ziaeian, MD5; Grace Y. Jenq, MD6; Harlan M. Krumholz, MD, SM2,7,8,9
[+] Author Affiliations
1Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
2Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
3Hospitalist Service, Yale–New Haven Hospital, New Haven, Connecticut
4Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
5Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles
6Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
7Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
8Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
9Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2013;173(18):1715-1722. doi:10.1001/jamainternmed.2013.9318.
Text Size: A A A
Published online

Importance  With growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding.

Objective  To conduct a multifaceted evaluation of transitional care from a patient-centered perspective.

Design  Prospective observational cohort study, May 2009 through April 2010.

Setting  Urban, academic medical center.

Participants  Patients 65 years and older discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia.

Main Outcomes and Measures  Discharge practices, including presence of follow-up appointment and patient-friendly discharge instructions; patient understanding of diagnosis and follow-up appointment; and patient perceptions of and satisfaction with discharge care.

Results  The 395 enrolled patients (66.7% of those eligible) had a mean age of 77.2 years. Although 349 patients (95.6%) reported understanding the reason they had been in the hospital, only 218 patients (59.6%) were able to accurately describe their diagnosis in postdischarge interviews. Discharge instructions routinely included symptoms to watch out for (98.4%), activity instructions (97.3%), and diet advice (89.7%) in lay language; however, 99 written reasons for hospitalization (26.3%) did not use language likely to be intelligible to patients. Of the 123 patients (32.6%) discharged with a scheduled primary care or cardiology appointment, 54 (43.9%) accurately recalled details of either appointment. During postdischarge interviews, 118 patients (30.0%) reported receiving less than 1 day’s advance notice of discharge, and 246 (66.1%) reported that staff asked whether they would have the support they needed at home before discharge.

Conclusions and Relevance  Patient perceptions of discharge care quality and self-rated understanding were high, and written discharge instructions were generally comprehensive although not consistently clear. However, follow-up appointments and advance discharge planning were deficient, and patient understanding of key aspects of postdischarge care was poor. Patient perceptions and written documentation do not adequately reflect patient understanding of discharge care.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Flow Diagram of Enrolled Participants
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Word Clouds of Common Phrases Describing Reason for Hospitalization

A, Thirty most common phrases describing reason for hospitalization in written discharge instructions to patients. B, One hundred most common phrases describing reason for hospitalization used by patients.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 3

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();