Quality of Discharge Practices and Patient Understanding at an Academic Medical Center | Acute Coronary Syndromes | JAMA Internal Medicine | JAMA Network
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Original Investigation
October 14, 2013

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

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
Abstract

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.

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