Not All Skilled Nursing Patients Seen Promptly By Physicians After Transfer From Hospital

MedicalResearch.com Interview with:

Kira L. Ryskina  MD MSAssistant Professor Of MedicineDivision of General Internal MedicinePerelman School of Medicine, University of Pennsylvania

Dr. Ryskina

Kira L. Ryskina  MD MS
Assistant Professor Of Medicine
Division of General Internal Medicine
Perelman School of Medicine,
University of Pennsylvania 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Post-acute care in skilled nursing facilities (SNF or sometimes called subacute rehab) is a very common discharge destination after a hospital stay. Patients discharged to these facilities represent more clinically complex and high-need patients than patients discharged home.

We wanted to understand how soon after discharge from the hospital to a skilled nursing facility are patients seen by a physician. We found that first visits by a physician or advanced practitioner (a nurse practitioner or physician assistant) for initial medical assessment occurred within four days of SNF admission in 71.5 percent of the stays. However, there was considerable variation in days to first visit at the regional, facility, and patient levels.

One in five initial physician visits occurred more than 4 days after admission to skilled nursing facilities.  In 10.4 percent of stays there was no physician or advanced practitioner visit. Much of the variability in visit timing had to do with SNF characteristics and geography compared to patient clinical or demographic characteristics. Patients who did not receive a physician visit had nearly double the rates of readmissions or deaths compared to patients who were seen.  Continue reading

Financial Incentives to Physicians Did Not Increase Hospital Discharge Follow-Up Visits

MedicalResearch.com Interview with:

Dr. Lauren Lapointe-Shaw, MD Physician at University Health Network Department of Medicine University of Toronto 

Dr. Lapointe-Shaw

Dr. Lauren Lapointe-Shaw, MD
Physician at University Health Network
Department of Medicine
University of Toronto 

MedicalResearch.com: What is the background for this study?

Response: Readmissions after hospital discharge are common and costly. We would like to reduce these as much as possible. Early physician follow-up post hospital discharge is one possible strategy to reduce readmissions. To this end, incentives to outpatient physicians for early follow-up have been introduced in the U.S. and Canada. We studied the effect of such an incentive, introduced to Ontario, Canada, in 2006.

Continue reading

Improved Hospital Discharge Process May Reduce Medication Nonadherence

Robin Mathews, MD Duke Clinical Research Institute Duke University Medical Center Durham, NCMedicalResearch.com Interview with:
Robin Mathews, MD
Duke Clinical Research Institute
Duke University Medical Center
Durham, NC

Medical Research: What is the background for this study? What are the main findings?

Dr. Mathews: Though treatment for patients with an acute myocardial infarction with evidence based therapies has increased significantly over the years, adherence to these therapies after discharge remain sub optimal. We used a validated instrument, the Morisky scale, to assess patient medication adherence.  We found that in a contemporary population of 7,425 patients across 216 hospitals, about 30% of patients were not adherent to prescribed cardiovascular medications as early as 6 weeks after discharge. Patients with low adherence were more likely to report financial hardship as well as have signs of depression. In addition, we found that patients who had follow up arranged prior to discharge and those that received explanations from the provider on the specific medications, were more often adherent to therapies. There was a non significant increase in risk of death or readmission at 2 months (HR [95% CI]: 1.35 [0.98-1.87]) among low adherence patients.

Continue reading

Hospital Discharge Practice: Room for Improvement in Communication, Comprehension

Leora I. Horwitz, MD, MHS Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, ConnecticutMedicalResearch.com Interview with:

Leora I. Horwitz, MD, MHS
Section of General Internal Medicine, Department of Medicine,
Yale School of Medicine,
Center for Outcomes Research and Evaluation,
Yale–New Haven Hospital, New Haven, Connecticut

MedicalResearch.com: What are the main findings of the study?

Answer: We interviewed nearly 400 older patients who had been admitted with heart failure, pneumonia or heart attack within one week of going home from the hospital. We also reviewed the medical records of 377 of the patients. We found, for example, that:

  • 40% of patients could not understand or explain the reason they were in the hospital in the first place;
  • A fourth of discharge instructions were written in medical jargon that a patient was not likely to understand;
  • Only a third of patients were discharged with scheduled follow-up with a primary care physician or cardiology specialist;
  • Only 44% accurately recalled details of their appointments.

In other words, we didn’t do a very good job of preparing patients for discharge, and perhaps as a result, patients were pretty confused about important things they needed to know after they were home.

We just published a companion paper in the Journal of Hospital Medicine last week in which we looked at the discharge summaries for the same patients – that is, the summary of the hospitalization that is meant to help the outpatient doctor understand what happened in the hospital. Turns out we were just as bad at communicating with doctors as with patients – we focused on details of the hospitalization rather than what needed to happen next or what needed to be followed up, and in a third of cases, we didn’t even send the summary to the outpatient doctor. In fact out of 377 discharge summaries, we didn’t find a single one that was done on the day of discharge, sent to the outpatient doctor, and included all key content recommended by major specialty societies.
Continue reading