title: Effect of standardized electronic discharge instructions on post-discharge hospital utilization.
abstract: BACKGROUND
  Several physician organizations and the Centers for Medicare and Medicaid Services (CMS) support compliance measures for written discharge instructions. CMS has identified clear discharge instructions with specific attention to medication management as a necessary intervention.
  
  
  OBJECTIVE
  We tested the hypothesis that implementing a standardized electronic discharge instructions document with embedded computerized medication reconciliation would decrease post-discharge hospital utilization.
  
  
  METHODS
  Retrospective pre- and post-implementation comparison cohort study.
  
  
  METHODS
  Subjects were hospitalized patients age 18 and older discharged between November 1, 2005 and October 31, 2006 (n = 16,572) and between March 1, 2007 and February 28, 2008 (n = 17,516).
  
  
  METHODS
  Implementation of a standardized, templated electronic discharge instructions document with embedded computerized medication reconciliation on December 18, 2006.
  
  
  METHODS
  The primary outcome was a composite variable of readmission or Emergency Department (ED) visit within 30 days of discharge. Secondary outcomes were the individual variables of readmissions and ED visits within 30 days.
  
  
  RESULTS
  The implementation of standardized electronic discharge instructions with embedded computerized medication reconciliation was not associated with a change in the primary composite outcome (adjusted OR 1.04, 95% CI 0.98-1.10) or the secondary outcome of 30-day ED visits (adjusted OR 0.98, 95% CI 0.98-1.10). There was an unexpected small but statistically significant increase in 30-day readmissions (adjusted OR 1.08, 95% CI 1.01-1.16).
  
  
  CONCLUSIONS
  Implementation of standardized electronic discharge instructions was not associated with reduction in post-discharge hospital utilization. More studies are needed to determine the reasons for post-discharge hospital utilization and to examine outcomes associated with proposed process-related recommendations.
authors.affiliation: Department of Medicine, Penn State College of Medicine, 500 University Drive, Mail Code HS04, Hershey, PA 17033, USA. jshowalter@hmc.psu.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Showalter
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Rafferty
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Swallow
authors.forename: Kolapo O
authors.initials: KO
authors.lastname: Dasilva
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Chuang
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000592:standards; D015331:Cohort Studies; D003194:Computer-Assisted Instruction / Q000592:standards*; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010351:Patient Discharge / Q000592:standards*; D010353:Patient Education as Topic / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult