title: Quality of discharge practices and patient understanding at an academic medical center.
abstract: OBJECTIVE
  With growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding.
  
  
  OBJECTIVE
  To conduct a multifaceted evaluation of transitional care from a patient-centered perspective.
  
  
  METHODS
  Prospective observational cohort study, May 2009 through April 2010.
  
  
  METHODS
  Urban, academic medical center.
  
  
  METHODS
  Patients 65 years and older discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia.
  
  
  METHODS
  Discharge practices, including presence of follow-up appointment and patient-friendly discharge instructions; patient understanding of diagnosis and follow-up appointment; and patient perceptions of and satisfaction with discharge care.
  
  
  RESULTS
  The 395 enrolled patients (66.7% of those eligible) had a mean age of 77.2 years. Although 349 patients (95.6%) reported understanding the reason they had been in the hospital, only 218 patients (59.6%) were able to accurately describe their diagnosis in postdischarge interviews. Discharge instructions routinely included symptoms to watch out for (98.4%), activity instructions (97.3%), and diet advice (89.7%) in lay language; however, 99 written reasons for hospitalization (26.3%) did not use language likely to be intelligible to patients. Of the 123 patients (32.6%) discharged with a scheduled primary care or cardiology appointment, 54 (43.9%) accurately recalled details of either appointment. During postdischarge interviews, 118 patients (30.0%) reported receiving less than 1 day’s advance notice of discharge, and 246 (66.1%) reported that staff asked whether they would have the support they needed at home before discharge.
  
  
  CONCLUSIONS
  Patient perceptions of discharge care quality and self-rated understanding were high, and written discharge instructions were generally comprehensive although not consistently clear. However, follow-up appointments and advance discharge planning were deficient, and patient understanding of key aspects of postdischarge care was poor. Patient perceptions and written documentation do not adequately reflect patient understanding of discharge care.
authors: Leora I
authors: LI
authors: Horwitz
authors: John P
authors: JP
authors: Moriarty
authors: Christine
authors: C
authors: Chen
authors: Robert L
authors: RL
authors: Fogerty
authors: Ursula C
authors: UC
authors: Brewster
authors: Sandhya
authors: S
authors: Kanade
authors: Boback
authors: B
authors: Ziaeian
authors: Grace Y
authors: GY
authors: Jenq
authors: Harlan M
authors: HM
authors: Krumholz
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D003266:Continuity of Patient Care / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000592:standards*; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D057566:Self Report
references: Ann Intern Med. 2009 Feb 3;150(3):178-87
references: 19189907
references: Am J Med. 2004 Oct 15;117(8):563-8
references: 15465504
references: Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72
references: 17278083
references: Arch Intern Med. 1997 May 12;157(9):1026-30
references: 9140275
references: J Emerg Med. 1997 Jan-Feb;15(1):1-7
references: 9017479
references: Arch Intern Med. 2003 Jan 13;163(1):83-90
references: 12523921
references: BMJ Qual Saf. 2011 Sep;20(9):773-8
references: 21515695
references: J Am Geriatr Soc. 2004 Jul;52(7):1051-9
references: 15209641
references: Mayo Clin Proc. 2005 Aug;80(8):991-4
references: 16092576
references: Med Care Res Rev. 2010 Feb;67(1):27-37
references: 19638641
references: Home Health Care Serv Q. 2007;26(4):93-104
references: 18032202
references: J Hosp Med. 2006 Nov;1(6):354-60
references: 17219528
references: Ann Emerg Med. 1995 Jan;25(1):71-4
references: 7802373
references: N Engl J Med. 2013 Jan 10;368(2):100-2
references: 23301730
references: J Emerg Nurs. 2011 Mar;37(2):138-40
references: 21397126
references: Isr Med Assoc J. 2003 Aug;5(8):567-70
references: 12929295
references: Ann Emerg Med. 2011 Apr;57(4):315-322.e1
references: 21035906
references: South Med J. 1996 Aug;89(8):770-4
references: 8701374
references: Front Health Serv Manage. 2009 Spring;25(3):11-32
references: 19382514
references: Am J Manag Care. 2011 Jan;17(1):41-8
references: 21348567
references: Qual Saf Health Care. 2006 Dec;15(6):414-7
references: 17142589
references: J Adv Nurs. 1996 Dec;24(6):1169-74
references: 8953352
references: J Am Coll Cardiol. 2012 Aug 14;60(7):607-14
references: 22818070
references: Am J Geriatr Psychiatry. 2004 Nov-Dec;12(6):639-47
references: 15545332
references: BMC Geriatr. 2012 Aug 24;12:47
references: 22920412
references: J Am Geriatr Soc. 1989 Aug;37(8):725-9
references: 2754157
references: Clin Geriatr Med. 1998 Nov;14(4):745-64
references: 9799477
references: J Am Coll Cardiol. 2007 Aug 14;50(7):e1-e157
references: 17692738
references: J Hosp Med. 2013 Aug;8(8):436-43
references: 23526813
references: Med Care. 2005 Mar;43(3):246-55
references: 15725981
references: Patient Educ Couns. 2005 Mar;56(3):276-82
references: 15721969
references: Mayo Clin Proc. 2008 May;83(5):554-8
references: 18452685
references: Eur Heart J. 2007 Oct;28(20):2525-38
references: 17951287
references: Ann Emerg Med. 2009 Apr;53(4):454-461.e15
references: 18619710
references: Ann Intern Med. 2003 Feb 4;138(3):161-7
references: 12558354
references: JAMA. 2010 May 5;303(17):1716-22
references: 20442387
references: Eur J Heart Fail. 2008 Oct;10(10):933-89
references: 18826876
references: Dement Geriatr Cogn Disord. 2010;29(3):259-64
references: 20375507
references: J Gen Intern Med. 2006 Aug;21(8):884-7
references: 16881952
references: J Patient Saf. 2011 Mar;7(1):19-25
references: 21921863
references: N Engl J Med. 2009 Dec 31;361(27):2637-45
references: 20042755
references: Ann Intern Med. 2011 Oct 18;155(8):520-8
references: 22007045
references: Image J Nurs Sch. 1996 Summer;28(2):143-7
references: 8690431
references: Gen Hosp Psychiatry. 2004 Jan-Feb;26(1):31-5
references: 14757300
references: J Gen Intern Med. 2012 Nov;27(11):1513-20
references: 22798200