title: Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care?
abstract: BACKGROUND
  Most nationally standardised quality measures use widely accepted evidence-based processes as their foundation, but the discharge instruction component of the United States standards of Joint Commission on Accreditation of Healthcare Organizations heart failure core measure appears to be based on expert opinion alone.
  
  
  OBJECTIVE
  To determine whether documentation of compliance with any or all of the six required discharge instructions is correlated with readmissions to hospital or mortality.
  
  
  METHODS
  A retrospective study at a single tertiary care hospital was conducted on randomly sampled patients hospitalised for heart failure from July 2002 to September 2003.
  
  
  METHODS
  Applying the Joint Commission on Accreditation of Healthcare Organizations criteria, 782 of 1121 patients were found eligible to receive discharge instructions. Eligibility was determined by age, principal diagnosis codes and discharge status codes.
  
  
  METHODS
  The primary outcome measures are time to death and time to readmission for heart failure or readmission for any cause and time to death.
  
  
  RESULTS
  In all, 68% of patients received all instructions, whereas 6% received no instructions. Patients who received all instructions were significantly less likely to be readmitted for any cause (p = 0.003) and for heart failure (p = 0.035) than those who missed at least one type of instruction. Documentation of discharge instructions is correlated with reduced readmission rates. However, there was no association between documentation of discharge instructions and mortality (p = 0.521).
  
  
  CONCLUSIONS
  Including discharge instructions among other evidence-based heart failure core measures appears justified.
authors.affiliation: Department of Health Sciences Research, Division of Health Care Policy & Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. vansuch.monica@mayo.edu
authors.forename: Monica
authors.initials: M
authors.lastname: VanSuch
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stroebel
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Huddleston
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Williams
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data; D000328:Adult; D004282:Documentation / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000592:standards*; D010353:Patient Education as Topic / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States