Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: A mixed methods study†‡§
The authors acknowledge funding from the Agency for Healthcare Research and Quality (AHRQ), 1 P20 HS017119 A model for effective communications for inpatient ambulatory transitions, and 1U18HS016967-01 Hospital Medicine and Economics, Center for Evaluation and Research in Therapeutics (CERT). They also acknowledge funding from the National Institutes on Aging (NIA), 1 T35 AG029795 Short-Term Aging-related Research Program, and the Hartford Geriatrics Health Outcomes Research Scholars Award. The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; or the decision to approve publication of the finished manuscript. Prior presentations of the data include the 2008 American College of Physicians Associates Day Regional Meeting in Chicago, Illinois, the 2009 American Geriatrics Society Meeting in Chicago, IL, and the 2009 Society of Hospital Medicine Meeting in Chicago, IL.
Dr. Arora, Ms. Prochaska, Dr. Farnan, Dr. Vinci, Mr. D'Arcy, Ms. Schwanz, Dr. Davis, and Dr. Johnson have no potential conflicts of interest. Potential conflicts of interest exist for Dr. David Meltzer with the following: National Institute of Health, Centers for Disease Control, Robert Wood Johnson Foundation, Pfizer, Merck, Lilly, Juvenile Diabetes Research Foundation, InHealth, and PeopleChart.
Dr. Arora had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the statistical analysis.
Abstract
BACKGROUND:
Communication and coordination with primary care physicians (PCPs) is recommended to ensure safe care transitions for hospitalized older patients. Understanding patient experiences of problems after discharge can help clinical teams design more patient-centered care transitions.
OBJECTIVE:
To report older patients' experiences with problems after hospital discharge and investigate whether PCPs were aware of their hospitalization.
DESIGN:
Prospective mixed methods study.
SETTING:
Single academic medical center.
PATIENTS:
Hospitalized patients and PCPs.
MEASUREMENTS:
Telephone interviews of frail, older general medical patients conducted 2 weeks after discharge to elicit patient problems after discharge, such as: (1) obtaining medications, or follow-up appointments; and (2) perceptions of hospital physician communication with their PCP. For each patient interviewed, their PCP was faxed a survey 2 weeks after discharge to assess awareness of hospitalization.
RESULTS:
Forty-two percent (27) of patients reported 42 different post-discharge problems. The most frequently reported problems were difficulty with follow-up appointments or tests (12). Other reported problems included readmission and return to the Emergency Department (10), problems with medications (8), not-prepared for discharge (8), and hospital complications or questions (4). Thirty percent of PCPs were unaware of patient hospitalization. Patients were twice as likely to report a problem if their PCP was unaware of the hospitalization (31% PCP aware, vs. 67% PCP not aware; P < 0.05).
CONCLUSION:
This study suggests that many frail, older patients reported problems after discharge and were twice as likely to do so when the patient's PCP was not aware of the hospitalization. Systematic interventions to improve communication with PCPs during patient hospitalization are needed. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
