John Showalter|Colleen Rafferty|Nicole A. Swallow|Kolapo O. DaSilva|Cynthia H. Chuang
Effect of Standardized Electronic Discharge Instructions on Post-Discharge Hospital Utilization
Pennsylvania State University|Penn State Milton S. Hershey Medical Center|Penn State Milton S. Hershey Medical Center|Penn State Milton S. Hershey Medical Center|Penn State Milton S. Hershey Medical Center
several physician organizations centers medicare medicaid services cms support compliance measures written discharge instructions cms identified clear discharge instructions specific attention medication management necessary interventionwe tested hypothesis implementing standardized electronic discharge instructions document embedded computerized medication reconciliation would decrease postdischarge hospital utilizationretrospective pre postimplementation comparison cohort studysubjects hospitalized patients age 18 older discharged november 1 2005 october 31 2006 n 16572 march 1 2007 february 28 2008 n 17516implementation standardized templated electronic discharge instructions document embedded computerized medication reconciliation december 18 2006the primary outcome composite variable readmission emergency department ed visit within 30 days discharge secondary outcomes individual variables readmissions ed visits within 30 daysthe implementation standardized electronic discharge instructions embedded computerized medication reconciliation associated change primary composite outcome adjusted 104 95 ci 098110 secondary outcome 30day ed visits adjusted 098 95 ci 098110 unexpected small statistically significant increase 30day readmissions adjusted 108 95 ci 101116implementation standardized electronic discharge instructions associated reduction postdischarge hospital utilization studies needed determine reasons postdischarge hospital utilization examine outcomes associated proposed processrelated recommendations