title: Joint Commission requirements for discharge instructions in patients with heart failure: is understanding important for preventing readmissions?
abstract: BACKGROUND
  Many approaches have been considered to reduce heart failure (HF) readmissions. The Joint Commission on Accreditation of Health Care Organizations (JC) requires hospitals to provide patients admitted for HF with discharge instructions that address 6 topics related to HF management: diet, exercise, weight monitoring, worsening symptoms, medications, and follow-up appointments. These guidelines were developed based on expert opinion, but no one has tested whether patients' understanding of these instructions affects 30-day readmission rates.
  
  
  RESULTS
  We conducted a prospective cohort study of patients admitted for decompensated HF. Patients completed an understanding survey immediately after their nurse read their discharge papers. The survey contained 1 question for each of the 6 JC topics. Of the 145 patients in the study, only 14 (10%) understood all 6 discharge instructions. Patients with complete comprehension of their discharge instructions were significantly less likely to be readmitted within 30 days than those with nonperfect understanding (P = .044), but this association was no longer significant after controlling for level of education and use of English as a primary language.
  
  
  CONCLUSIONS
  HF patients' comprehension of discharge instructions is inadequate. Patients with limited education and those that do not speak English as a primary language are more likely to have poorer discharge understanding and higher rates of 30-day readmissions.
authors.affiliation: Columbia University Medical Center, NewYork Presbyterian Hospital, New York, New York. Electronic address: jrr2155@columbia.edu.
authors.forename: Ricky
authors.initials: R
authors.lastname: Regalbuto
authors.affiliation: Columbia University Medical Center, NewYork Presbyterian Hospital, New York, New York.
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.affiliation: Columbia University Medical Center, NewYork Presbyterian Hospital, New York, New York.
authors.forename: David
authors.initials: D
authors.lastname: Chapel
authors.affiliation: Columbia University Medical Center, NewYork Presbyterian Hospital, New York, New York.
authors.forename: Jenniliz
authors.initials: J
authors.lastname: Mendez
authors.affiliation: Columbia University Medical Center, NewYork Presbyterian Hospital, New York, New York.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
mesh_terms: D003144:Communication Barriers; D032882:Comprehension; D004522:Educational Status; D005260:Female; D057220:Health Literacy; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D008875:Middle Aged; D063886:Patient Discharge Summaries / Q000592:standards*; D010353:Patient Education as Topic / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: Discharge; HF-1; readmission