title: Features of high quality discharge planning for patients following acute myocardial infarction.
abstract: BACKGROUND
  Hospital discharge planning is required as a Medicare Condition of Participation (CoP), and is essential to the health and safety for all patients. However, there have been no studies examining specific hospital discharge processes, such as patient education and communication with primary care providers, in relation to hospital 30-day risk standardized mortality rates (RSMRs) for patients with acute myocardial infarction (AMI).
  
  
  OBJECTIVE
  To identify hospital discharge processes that may be associated with better performance in hospital AMI care as measured by RSMR.
  
  
  METHODS
  We conducted a qualitative study of U.S. Hospitals, which were selected based on their RSMR reported by the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website for the most recent data available (January 1, 2005 - December 31, 2007). We selected hospitals that ranked in the top 5 % and the bottom 5 % of RSMR for the two consecutive years. We focused on hospitals at the extreme ends of the range in RSMR, known as deviant case sampling. We excluded hospitals that did not have the ability to perform percutaneous coronary intervention in order to decrease the heterogeneity in our sample.
  
  
  METHODS
  Participants included key hospital clinical and administrative staff most involved in discharge planning for patients admitted with AMI.
  
  
  METHODS
  We conducted 14 site visits and 57 in-depth interviews using a standard discussion guide. We employed a grounded theory approach and used the constant comparative method to generate recurrent and unifying themes.
  
  
  RESULTS
  We identified five broad discharge processes that distinguished higher and lower performing hospitals: 1) initiating discharge planning upon patient admission; 2) using multidisciplinary case management services; 3) ensuring that a follow-up plan is in place prior to discharge; 4) providing focused education sessions for both the patient and family; and 5) contacting the primary care physician regarding the patient's hospitalization and follow-up care plan.
  
  
  CONCLUSIONS
  Comprehensive and more intense discharge processes that start on admission continue during the patient's hospital stay, and follow up with the primary care physician within 2 days post-discharge, may be critical in reducing hospital RSMR for patients with AMI.
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06520-8034, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Cherlin
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Thompson
authors.forename: S Ryan
authors.initials: SR
authors.lastname: Greysen
authors.forename: Erica
authors.initials: E
authors.lastname: Spatz
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D019090:Case Management / Q000458:organization & administration / Q000592:standards; D005190:Family; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D007373:Interinstitutional Relations; D008134:Long-Term Care / Q000458:organization & administration / Q000592:standards; D009203:Myocardial Infarction / Q000401:mortality* / Q000534:rehabilitation; D010343:Patient Admission; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D010351:Patient Discharge / Q000592:standards*; D010353:Patient Education as Topic / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology