Perceived discharge quality and associations with hospital readmissions and emergency department use: a prospective cohort study

Abstract

BackgroundAt hospital discharge, care is handed over from providers to patients. Discharge encounters must prepare patients to self-manage their health, but have been found to be suboptimal. Our study objectives were to describe and determine the correlates of perceived discharge quality and to explore the association between perceived discharge quality and postdischarge outcomes.MethodsWe conducted a prospective cohort study in medical inpatients admitted to a tertiary care hospital in Calgary, Canada. Perceived discharge quality was measured by the Care Transitions Measure (CTM). Linkage to administrative databases provided data for the composite outcome—90-day hospital readmission or emergency department visit. Logistic regression modelling was used to determine the association between global CTM scores, and the individual CTM components, and the composite outcome.ResultsA total of 316 patients were included in the analysis. The median CTM score was 80.0 (IQR 66.6–100.0). The distribution of CTM scores were significantly different based on comorbidity burden, with the median and maximum CTM scores being lower and the IQR being narrower, for those with six or more comorbidities compared with those with fewer comorbidities. CTM scores were not associated with the composite outcome, though a single CTM item—not understanding warning signs and symptoms—was (adjusted OR 3.46 (95% CI 1.02 to 11.73)).ConclusionPerceived quality of discharge varies based on patient burden of comorbidities. While global perceived discharge quality was not associated with postdischarge outcomes, lack of patient understanding of warning symptoms was. Discharging healthcare teams should pay special attention to these priority patient groups and specific discharge process components.

Rural caregivers’ preparedness for detecting and responding to the signs of worsening health conditions in recently hospitalised patients at risk for readmission: a qualitative descriptive study

“… 9 However, that same study found that other aspects of preparedness (eg, managing medications) and overall preparedness for postdischarge care did not predict ER visits or hospital readmission. 9 Despite this prior research, our study findings suggest that there appears to be a fundamental gap with respect to preparing caregivers for this critical aspect of postdischarge care.…”

“…Yet, awareness of warning signs is considered a key aspect of preparedness for managing postdischarge care10 and evidence suggests that it is closely tied to hospital readmission. A recent study, for instance, found that compared with medical patients who knew the warning signs to monitor after hospital discharge, those who did not know the signs were almost 3.5 times significantly more likely to visit the ER or be readmitted to hospital 9. However, that same study found that other aspects of preparedness (eg, managing medications) and overall preparedness for postdischarge care did not predict ER visits or hospital readmission 9.…”

“…A recent study, for instance, found that compared with medical patients who knew the warning signs to monitor after hospital discharge, those who did not know the signs were almost 3.5 times significantly more likely to visit the ER or be readmitted to hospital 9. However, that same study found that other aspects of preparedness (eg, managing medications) and overall preparedness for postdischarge care did not predict ER visits or hospital readmission 9. Despite this prior research, our study findings suggest that there appears to be a fundamental gap with respect to preparing caregivers for this critical aspect of postdischarge care.…”

“… 6 7 Consequently, informal caregivers such as their friends and families often play a key role in providing postdischarge care to these patients. 8 A critical aspect of postdischarge care is identifying the signs of worsening health conditions and determining what to do 9 10 yet, few studies have examined caregivers’ perspectives of their preparedness to do so.…”

Clustering Disease of Clostridioides Difficile Infection: Implication for the Management in Internal Medicine

“…Unlike multimorbidity, which implies the simultaneous presence in the same individual of two or more acute or chronic conditions, comorbidity presupposes the coexistence of any pathological event during the clinical course of a certain main disease (index disease), which is complicated by a possible hierarchical order of events between the initial pathology and the contingent conditions [2,3]. The different coexisting conditions in the same individual can influence each other, and it is able to influence the outcome of the treatments of the other coexisting ones, through various modalities: the limitation of life expectancy, the increased intercurrent morbidity, the interactions between pharmacological therapies, and the impossibility of full use of adequate treatments due to contraindications [4]. Grouping the diseases in two or more specific and concomitant conditions in the same patient can contribute to a greater knowledge of the various aspects and of the evolution a main condition may undergo.…”