Leora I. Horwitz|John Moriarty|Christine Chen|Robert L. Fogerty|Ursula C. Brewster|Sandhya Kanade|Boback Ziaeian|Grace Jenq|Harlan M. Krumholz
Quality of Discharge Practices and Patient Understanding at an Academic Medical Center
Yale University|Yale New Haven Hospital|Yale University|Yale New Haven Hospital|Yale University|Yale University|Yale New Haven Hospital|University of California, Los Angeles|Yale University|Yale New Haven Hospital|Yale New Haven Health System|Robert Wood Johnson Foundation|Yale University
h3importanceh3 growing national focus reducing readmissions need comprehensively assess quality transitional care including discharge practices patient perspectives patient understanding h3objectiveh3 conduct multifaceted evaluation transitional care patientcentered perspective h3designh3 prospective observational cohort study may 2009 april 2010 h3settingh3 urban academic medical center h3participantsh3 patients 65 years older discharged home hospitalization acute coronary syndrome heart failure pneumonia h3main outcomes measuresh3 discharge practices including presence followup appointment patientfriendly discharge instructions patient understanding diagnosis followup appointment patient perceptions satisfaction discharge care h3resultsh3 395 enrolled patients 667 eligible mean age 772 years although 349 patients 956 reported understanding reason hospital 218 patients 596 able accurately describe diagnosis postdischarge interviews discharge instructions routinely included symptoms watch 984 activity instructions 973 diet advice 897 lay language however 99 written reasons hospitalization 263 use language likely intelligible patients 123 patients 326 discharged scheduled primary care cardiology appointment 54 439 accurately recalled details either appointment postdischarge interviews 118 patients 300 reported receiving less 1 days advance notice discharge 246 661 reported staff asked whether would support needed home discharge h3conclusions relevanceh3 patient perceptions discharge care quality selfrated understanding high written discharge instructions generally comprehensive although consistently clear however followup appointments advance discharge planning deficient patient understanding key aspects postdischarge care poor patient perceptions written documentation adequately reflect patient understanding discharge care