Patients' ratings of the in-hospital discharge briefing and post-discharge primary care follow-up: The association with 30-day readmissions. Issue 8 (August 2019)

• Record Type: Journal Article
• Authors: Rayan-Gharra, Nosaiba; Shadmi, Efrat; Tadmor, Boaz; Flaks-Manov, Natalie; Balicer, Ran D.
• Is Part Of: Patient education and counseling. Volume 102:Issue 8(2019)
• Page Start: 1513
• Page End: 1519
• Publication Date: 2019-08
• Subjects: 30-Day readmission -- Discharge briefing -- Primary care visit -- Post-discharge follow up care; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2019.03.018
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: Primary care physicians (PCP) should provide review of the discharge-summary letter. The PCP's post-discharge review reinforces the in-hospital discharge explanations. This post-discharge review serves as a protective factor for 30-day readmissions. Abstract: Objective: We examined whether patients' ratings of their in-hospital discharge briefing and their post-discharge Primary Care Physicians' (PCP) review of the discharge summary are associated with 30-day readmissions. Methods: A prospective study of 594 internal-medicine patients at a tertiary medical-center in Israel. The in-hospital baseline questionnaire included sociodemographic characteristics, physical, mental, and functional health status. Patients were surveyed by phone about the discharge and post-discharge processes. Clinical data and health-service use was retrieved from a central data-warehouse. Multivariate regressions modeled the relationship between in-hospital baseline characteristics, discharge briefing, PCP visit indicator, the PCP discharge summary review, and 30-day readmissions. Results: The extent of the PCPs' review of the hospital discharge summary at the post-discharge visit was rated higher than the in-hospital discharge briefing (3.46 vs. 3.17, p = 0.001) and was associated with lower odds of readmission (OR=0.35, 95% CI 0.26–0.45). The model that included this assessment performed better than the in-hospital baseline, the in-hospital discharge-briefing, and the PCP visit models (C-statistic = 0.87, compared with: 0.70, 0.81, 0.81, respectively). Conclusions: Providing extensive post-discharge explanations by PCPs serves as a significant protective factor against readmissions. Practice implications: PCPs should be encouraged to thoroughly review the discharge summary letter with the patient.