Effect of Standardized Electronic Discharge Instructions on Post-Discharge Hospital Utilization
- 718 Downloads
Several physician organizations and the Centers for Medicare and Medicaid Services (CMS) support compliance measures for written discharge instructions. CMS has identified clear discharge instructions with specific attention to medication management as a necessary intervention.
We tested the hypothesis that implementing a standardized electronic discharge instructions document with embedded computerized medication reconciliation would decrease post-discharge hospital utilization.
Retrospective pre- and post-implementation comparison cohort study.
Subjects were hospitalized patients age 18 and older discharged between November 1, 2005 and October 31, 2006 (n = 16,572) and between March 1, 2007 and February 28, 2008 (n = 17,516).
Implementation of a standardized, templated electronic discharge instructions document with embedded computerized medication reconciliation on December 18, 2006.
The primary outcome was a composite variable of readmission or Emergency Department (ED) visit within 30 days of discharge. Secondary outcomes were the individual variables of readmissions and ED visits within 30 days.
The implementation of standardized electronic discharge instructions with embedded computerized medication reconciliation was not associated with a change in the primary composite outcome (adjusted OR 1.04, 95% CI 0.98–1.10) or the secondary outcome of 30-day ED visits (adjusted OR 0.98, 95% CI 0.98–1.10). There was an unexpected small but statistically significant increase in 30-day readmissions (adjusted OR 1.08, 95% CI 1.01–1.16).
Implementation of standardized electronic discharge instructions was not associated with reduction in post-discharge hospital utilization. More studies are needed to determine the reasons for post-discharge hospital utilization and to examine outcomes associated with proposed process-related recommendations.
KEY WORDSmedical informatics hospital medicine performance measurement readmission health care utilization
Cynthia Chuang MD, MSc, is funded, in part, by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23 051634).
Conflict of Interest
- 5.Centers for Medicare and Medicaid Services. Application of incentives to reduce avoidable readmissions to hospitals. Fed Regist. 2008;73:23673–5.Google Scholar
- 6.Snow V, Beck D, Budnitz T, et al. Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine. J Gen Intern Med. 2009;24:971–6.PubMedCrossRefGoogle Scholar
- 7.VanSuch M, Naessens JM, Stroebel RJ, Huddleston JM, Williams AR. Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care? Qual Saf Health Care. 2006;15:414–7.PubMedCrossRefGoogle Scholar