Hospital to Post-Acute Care Facility Transfers: Identifying Targets for Information Exchange Quality Improvement.
Information exchange is critical to high-quality care transitions from hospitals to post-acute care (PAC) facilities. We conducted a survey to evaluate the completeness and timeliness of information transfer and communication between a tertiary-care academic hospital and its related PAC facilities.



This was a cross-sectional Web-based 36-question survey of 110 PAC clinicians and staff representing 31 PAC facilities conducted between October and December 2013.



We received responses from 71 of 110 individuals representing 29 of 31 facilities (65% and 94% response rates). We collapsed 4-point Likert responses into dichotomous variables to reflect completeness (sufficient vs insufficient) and timeliness (timely vs not timely) for information transfer and communication. Among respondents, 32% reported insufficient information about discharge medical conditions and management plan, and 83% reported at least occasionally encountering problems directly related to inadequate information from the hospital. Hospital clinician contact information was the most common insufficient domain. With respect to timeliness, 86% of respondents desired receipt of a discharge summary on or before the day of discharge, but only 58% reported receiving the summary within this time frame. Through free-text responses, several participants expressed the need for paper prescriptions for controlled pain medications to be sent with patients at the time of transfer.



Staff and clinicians at PAC facilities perceive substantial deficits in content and timeliness of information exchange between the hospital and facilities. Such deficits are particularly relevant in the context of the increasing prevalence of bundled payments for care across settings as well as forthcoming readmissions penalties for PAC facilities. Targets identified for quality improvement include structuring discharge summary information to include information identified as deficient by respondents, completion of discharge summaries before discharge to PAC facilities, and provision of hard-copy opioid prescriptions at discharge.
Hospital Medicine Section, Division of General Internal Medicine, University of Colorado Denver School of Medicine, Aurora, CO. Electronic address: christine.jones@ucdenver.edu.
Christine D
CD
Jones
Hospital Medicine Section, Division of General Internal Medicine, University of Colorado Denver School of Medicine, Aurora, CO.
Ethan
E
Cumbler
Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO.
Benjamin
B
Honigman
Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO; Division of General Internal Medicine, University of Colorado Denver School of Medicine, Aurora, CO.
Robert E
RE
Burke
Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO.
Rebecca S
RS
Boxer
Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO; Division of Health Care Policy and Research, University of Colorado Denver School of Medicine, Aurora, CO.
Cari
C
Levy
Division of Health Care Policy and Research, University of Colorado Denver School of Medicine, Aurora, CO.
Eric A
EA
Coleman
Division of Health Care Policy and Research; Hospital Medicine Section, Division of General Internal Medicine University of Colorado Denver School of Medicine, Aurora, CO.
Heidi L
HL
Wald
D003430:Cross-Sectional Studies; D066275:Health Information Exchange / Q000592:standards*; D006761:Hospitals; D006801:Humans; D010351:Patient Discharge; D010360:Patient Transfer; D058996:Quality Improvement; D019467:Subacute Care; D011795:Surveys and Questionnaires
Care coordination; care transitions; post-acute care