Effects of Discharge Planning and Compliance With Outpatient Appointments on Readmission Rates

Nelson, E. Anne; Maruish, Mark E.; Axler, Joel L.

doi:10.1176/appi.ps.51.7.885

Cited by 202 publications

(175 citation statements)

References 12 publications

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“…[34][35][36][37] Our study design allowed examination of predictors of compliance without confounding by non-comprehension, in contrast with recent studies conducted among hospital inpatients. 1,29 Our results suggest that increased comprehension may not improve compliance for all patients.…”

Section: Discussionmentioning

confidence: 99%

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

et al. 2014

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BACKGROUND: Little is known regarding the prevalence or risk factors for non-comprehension and noncompliance with discharge instructions among older adults. OBJECTIVE: To quantify the prevalence of noncomprehension and non-compliance with discharge instructions and to identify associated patient characteristics. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: Four hundred and fifty adults aged ≥ 65 admitted to medical and surgical units of a tertiary care facility and meeting inclusion criteria. MEASURES: We collected information on demographics, psycho-social factors, discharge diagnoses, and medications using surveys and patient medical records. Domains within discharge instructions included medications, follow-up appointments, diet, and exercise. At 5 days post-discharge, we assessed comprehension by asking patients about their discharge instructions, and compared responses to written instructions from medical charts. We assessed compliance among patients who understood their instructions. RESULTS: Prevalence of non-comprehension was 5 % for follow-up appointments, 27 % for medications, 48 % for exercise and 50 % for diet recommendations. Age was associated with non-comprehension of medication [odds ratio (OR) 1.07; 95 % confidence interval (CI) 1.04, 1.12] and follow-up appointment (OR 1.08; 95 % CI 1.00, 1.17) instructions. Male sex was associated with noncomprehension of diet instructions (OR 1.91; 95 % CI 1.10, 3.31). Social isolation was associated with noncomprehension of exercise instructions (OR 9.42; 95 % CI 1.50, 59.11) Depression was associated with noncompliance with medication (OR 2.29; 95 % CI 1.02, 5.10) and diet instructions (OR 3.30; 95 % CI 1.24, 8.83). CONCLUSIONS: Non-comprehension of discharge instructions among older adults is prevalent, multifactorial, and varies by domain.

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Section: Discussionmentioning

confidence: 99%

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

et al. 2014

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“…[115][116][117][118] Repeat hospitalisation may be a result of one or a combination of several factors including (but not limited to) quality of care during previous hospitalisation (including early discharge), comprehensive discharge planning, 119 primary and community care after discharge (including outpatient follow-up) 120 and the patients' own social support systems and health behaviours. Therefore, repeat hospitalisation is an important indicator of the quality-of-care co-ordination between hospital care, primary care and community care settings.…”

Section: Doi: 103310/hsdr04260 Health Services and Delivery Researchmentioning

confidence: 99%

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Cookson

Asaria

Ali

et al. 2016

Health Serv Deliv Res

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Background: Inequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them. Objectives: The objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format. Design: Longitudinal whole-population study at the small-area level. Setting: England from 2001/2 to 2011/12. Participants: A total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people. Main outcome measures: Slope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality. Data sources: Practice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8). Results: Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark. Limitations: General practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible. Conclusions: NHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any admini...

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“…CMS has acknowledged this, and in their proposed rule, Reform of Requirements for Long-Term Care Facilities ( § 483. 20), recommend that in addition to documentation of the transition and/or discharge from nursing facilities, specific patient information be exchanged with the receiving provider (e.g., PCP). 17 However, they do not further specify how the communication should occur or require a specific format.…”

Section: Policy Implications and Future Researchmentioning

confidence: 99%

“…Evidence has shown that patients who follow up promptly with their PCPs after a hospitalization have improved outcomes, including fewer medication errors. [20][21][22][23] In an effort to reduce length of stay (LOS) and adverse events in the hospital, SNF physicians are being asked to provide care for more acutely ill patients. 24 Essentially, SNFs are becoming stepdown hospitals.…”

Section: Responsibilitiesmentioning

confidence: 99%

SGIM-AMDA-AGS Consensus Best Practice Recommendations for Transitioning Patients’ Healthcare from Skilled Nursing Facilities to the Community

et al. 2016

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We assembled a cross-cutting team of experts representing primary care physicians (PCPs), home care physicians, physicians who see patients in skilled nursing facilities (SNF physicians), skilled nursing facility medical directors, human factors engineers, transitional care researchers, geriatricians, internists, family practitioners, and three major organizations: AMDA, SGIM, and AGS. This work was sponsored through a grant from the Association of Subspecialty Physicians (ASP). Members of the team mapped the process of discharging patients from a skilled nursing facility into the community and subsequent care of their outpatient PCP. Four areas of process improvement were identified, building on the prior work of the AMDA Transitions of Care Committee and the experiences of the team members. The team identified issues and developed best practices perceived as feasible for SNF physician and PCP practices to accomplish. The goal of these consensus-based recommended best practices is to provide a safe and high-quality transition for patients moving between the care of their SNF physician and PCP.

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Effects of Discharge Planning and Compliance With Outpatient Appointments on Readmission Rates

Cited by 202 publications

References 12 publications

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

SGIM-AMDA-AGS Consensus Best Practice Recommendations for Transitioning Patients’ Healthcare from Skilled Nursing Facilities to the Community

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