title: Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis.
abstract: OBJECTIVE
  Effective communication between inpatient and outpatient providers may mitigate risks of adverse events associated with hospital discharge. However, there is an absence of pediatric literature defining effective discharge communication strategies at both freestanding children's hospitals and general hospitals. The objectives of this study were to assess associations between pediatric primary care providers' (PCPs) reported receipt of discharge communication and referral hospital type, and to describe PCPs' perspectives regarding effective discharge communication and areas for improvement.
  
  
  METHODS
  We administered a questionnaire to PCPs referring to 16 pediatric hospital medicine programs nationally. Multivariable models were developed to assess associations between referral hospital type and receipt and completeness of discharge communication. Open-ended questions asked respondents to describe effective strategies and areas requiring improvement regarding discharge communication. Conventional qualitative content analysis was performed to identify emergent themes.
  
  
  RESULTS
  Responses were received from 201 PCPs, for a response rate of 63%. Although there were no differences between referral hospital type and PCP-reported receipt of discharge communication (relative risk 1.61, 95% confidence interval 0.97-2.67), PCPs referring to general hospitals more frequently reported completeness of discharge communication relative to those referring to freestanding children's hospitals (relative risk 1.78, 95% confidence interval 1.26-2.51). Analysis of free text responses yielded 4 major themes: 1) structured discharge communication, 2) direct personal communication, 3) reliability and timeliness of communication, and 4) communication for effective postdischarge care.
  
  
  CONCLUSIONS
  This study highlights potential differences in the experiences of PCPs referring to general hospitals and freestanding children's hospitals, and presents valuable contextual data for future quality improvement initiatives.
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, Mass. Electronic address: jleyenaar@post.harvard.edu.
authors.forename: JoAnna K
authors.initials: JK
authors.lastname: Leyenaar
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, John A Burns School of Medicine, Honolulu, Hi.
authors.forename: Lora
authors.initials: L
authors.lastname: Bergert
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland, Me.
authors.forename: Leah A
authors.initials: LA
authors.lastname: Mallory
authors.affiliation: University of Arizona College of Medicine-Phoenix, Phoenix Children's Hospital, Phoenix, Ariz.
authors.forename: Richard
authors.initials: R
authors.lastname: Engel
authors.affiliation: Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, Calif.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rassbach
authors.affiliation: Dell Children's Medical Center of Central Texas, Austin, Tex.
authors.forename: Mark
authors.initials: M
authors.lastname: Shen
authors.affiliation: Michigan State University College of Osteopathic Medicine, East Lansing, Mich.
authors.forename: Tess
authors.initials: T
authors.lastname: Woehrlen
authors.affiliation: Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pa.
authors.forename: David
authors.initials: D
authors.lastname: Cooperberg
authors.affiliation: Warren Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI.
authors.forename: Daniel
authors.initials: D
authors.lastname: Coghlin
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D006760:Hospitalization; D006769:Hospitals, General; D006776:Hospitals, Pediatric; D006801:Humans; D015999:Multivariate Analysis; D010351:Patient Discharge; D063886:Patient Discharge Summaries; D010372:Pediatrics; D010821:Physicians, Family; D058007:Physicians, Primary Care; D011795:Surveys and Questionnaires
keywords: children; collaborative; discharge communication; medical home; transitions of care