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Effect of discharge summary availability during post-discharge visits on hospital readmission

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Abstract

OBJECTIVE: To determine if the delivery of hospital discharge summaries to follow-up physicians decreases the risk of hospital readmission.

SUBJECTS: Eight hundred eighty-eight patients discharged from a single hospital following treatment for an acute medical illness.

SETTING: Teaching hospital in a universal health-care system.

DESIGN: We determined the date that each patient’s discharge summary was printed and the physicians to whom it was sent. Summary receipt was confirmed by survey and phoning each physician’s office. Each patient’s hospital chart was reviewed to determine their acute and chronic medical conditions as well as their course in hospital. Using population-based administrative databases, all post-hospitalization visits were identified. For each of these visits, we determined whether the summary was available.

MAIN OUTCOME MEASURES: Time to nonelective hospital readmission during 3 months following discharge.

RESULTS: The discharge summary was available for only 568 of 4,639 outpatient visits (12.2%). Overall, 240 (27.0%) of patients were urgently readmitted to hospital. After adjusting for significant patient and hospitalization factors, we found a trend toward a decreased risk of readmission for patients who were seen in follow-up by a physician who had received a summary (relative risk 0.74, 95% confidence interval 0.50 to 1.11).

CONCLUSIONS: The risk of rehospitalization may decrease when patients are assessed following discharge by physicians who have received the discharge summary. Further research is required to determine if better continuity of patient information improves patient outcomes.

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References

  1. Stewart MA. Effective physician-patient communication and health outcomes: a review. Can Med Assoc J. 1995;152:1423–33.

    CAS  Google Scholar 

  2. Gosbee J. Communication among health professionals. BMJ. 1998;316:642.

    PubMed  CAS  Google Scholar 

  3. Coutts J. Health records should be electronic, experts say. Globe and Mail March. 1998;15:A4.

    Google Scholar 

  4. Capen K. Findings of negligence followed communication lapses in BC aneurysm case. Can Med J Assoc. 1997;156:49–51.

    CAS  Google Scholar 

  5. Dougherty GE. “Conventional” dictated versus database-generated discharge summaries. Can Med J Assoc. 1999;160:345–6.

    CAS  Google Scholar 

  6. Epstein RM. Communication between primary care physicians and consultants. Arch Fam Med. 1995;4:403–9.

    Article  PubMed  CAS  Google Scholar 

  7. Robertson CL, Kopans DB. Communication problems after mammographic screening. Radiology. 1989;172:443–4.

    PubMed  CAS  Google Scholar 

  8. Branger PJ, van’t Hooft A, van der Wouden JC, Duisterhout JS, van Bemmel JH. Shared care for diabetes: supporting communication between primary and secondary care. Med Inf. 1998;91:412–6.

    Google Scholar 

  9. Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987;107:569–74.

    PubMed  CAS  Google Scholar 

  10. Montalto M, Harris P, Rosengarten P. Impact of general practitioners’ referral letters to an emergency department. Aust Fam Physician. 1324;23:1320–1.

    Google Scholar 

  11. Crone P. Are preadmission general practitioner telephone calls of value? A study in communication. N Z Med J. 1987;100:632–4.

    PubMed  CAS  Google Scholar 

  12. Ferguson JA, Goldacre MJ, Henderson J, Gillmer MD. Audit of workload in gynaecology: analysis of time trends from linked statistics. Br J Obstet Gynaecol. 1991;98:772–7.

    PubMed  CAS  Google Scholar 

  13. Goldmann DR. The hospitalist movement in the United States: what does it mean for internists? Ann Intern Med. 1999;130:326–7.

    PubMed  CAS  Google Scholar 

  14. Wachter RM. An introduction to the hospitalist model. Ann Intern Med. 1999;130:338–42.

    PubMed  CAS  Google Scholar 

  15. Lindenauer PK, Pantilat SZ, Katz PP, Wachter RM. Hospitalists and the practice of inpatient medicine: results of a survey of the National Association of Inpatient Physicians. Ann Intern Med. 1999;130:343–9.

    PubMed  CAS  Google Scholar 

  16. Sox HC. The hospitalist model: perspectives of the patient, the internist, and internal medicine. Ann Intern Med. 1999;130:368–72.

    PubMed  CAS  Google Scholar 

  17. Kelley MA. The hospitalist: a new medical specialty? Ann Intern Med. 1999;130:373–5.

    PubMed  CAS  Google Scholar 

  18. Showstack J, Katz PP, Weber E. Evaluating the impact of hospitalists. Ann Intern Med. 1999;130:376–81.

    PubMed  CAS  Google Scholar 

  19. Long A, Atkins JB. Communications between general practitioners and consultants. BMJ. 1974;4:456–9.

    PubMed  CAS  Google Scholar 

  20. Tulloch AJ, Fowler GH, McMullan JJ, Spence JM. Hospital discharge reports: content and design. BMJ. 1975;4:443–6.

    PubMed  CAS  Google Scholar 

  21. Mageean RJ. Study of “discharge communications” from hospital. BMJ Clin Res Ed. 1986;293:1283–4.

    CAS  Google Scholar 

  22. van Walraven C, Weinberg AL. Quality assessment of a discharge summary system. Can Med Assoc J. 1995;152:1437–42.

    Google Scholar 

  23. Macaulay EM, Cooper GG, Engeset J, Naylor AR. Prospective audit of discharge summary errors. Br J Surg. 1996;83:788–90.

    Article  PubMed  CAS  Google Scholar 

  24. Geitung JT, Kolstrup N, Fugelli P. Written information from hospital to primary physician about discharged patients. Tidsskr Nor Laegeforen. 1990;110:3132–5.

    PubMed  CAS  Google Scholar 

  25. van Walraven C, Laupacis A, Seth R, Wells GA. Dictated versus database discharge summaries: a randomized controlled trial. Can Med Assoc J. 1999;160:319–26.

    Google Scholar 

  26. Sandler DA, Mitchell JR. Interim discharge summaries: how are they best delivered to general practitioners? BMJ Clin Res Ed. 1987;295:1523–5.

    CAS  Google Scholar 

  27. Allison PD. Estimating Cox-regression models with PROC PHREG. In: Anonymous Survival Analysis Using the SAS System. Cary, NC: SAS Institute Inc.; 2000:111–84.

    Google Scholar 

  28. Dietrich AJ, Marton KI. Does continuous care from a physician make a difference? J Fam Pract. 1982;15:929–37.

    PubMed  CAS  Google Scholar 

  29. Wasson JH, Sauvigne AE, Mogielnicki RP, et al. Continuity of outpatient medical care in elderly men. A randomized trial. JAMA. 1984;252:2413–7.

    Article  PubMed  CAS  Google Scholar 

  30. Einstadter D, Cebul RD, Franta PR. Effect of a nurse case manager on postdischarge follow-up. J Gen Intern Med. 1996;11:684–8.

    Article  PubMed  CAS  Google Scholar 

  31. Fitzgerald JF, Smith DM, Martin DK, Freedman JA, Katz BP. A case manager intervention to reduce readmissions. Arch Intern Med. 1994;154:1721–9.

    Article  PubMed  CAS  Google Scholar 

  32. Wagner E, Duggan MA. Effectiveness of follow-up letters to health care providers in triggering follow-up for women with abnormal results on Papanicolaou testing. Can Med Assoc J. 2001;164:207–8.

    CAS  Google Scholar 

  33. Williams EI, Fitton F. General practitioner response to elderly patients discharged from hospital. BMJ. 1990;300:159–61.

    PubMed  CAS  Google Scholar 

  34. Krumholz HM, Parent EM, Tu N, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 1997;157:99–104.

    Article  PubMed  CAS  Google Scholar 

  35. Boult C, Dowd B, McCaffrey D, Boult L, Hernandez R, Krulewitch H. Screening elders for risk of hospital admission. J Am Geriatr Soc. 1993;41:811–7.

    PubMed  CAS  Google Scholar 

  36. Alexander M, Grumbach K, Remy L, Rowell R, Massie BM. Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity. Am J Heart. 1999;137:919–27.

    Article  CAS  Google Scholar 

  37. Corrigan JM, Martin JB. Identification of factors associated with hospital readmission and development of a predictive model. Health Serv Res. 1992;27:81–101.

    PubMed  CAS  Google Scholar 

  38. Holloway JJ, Medendorp SV, Bromberg J. Risk factors for early readmission among veterans. Health Serv Res. 1990;25:213–37.

    PubMed  CAS  Google Scholar 

  39. Lahey SJ, Campos CT, Jennings B, Pawlow P, Stokes T, Levitsky S. Hospital readmission after cardiac surgery. Does “fast track” cardiac surgery result in cost saving or cost shifting? Circulation. 1998;98(Supplement 2):35–40.

    Google Scholar 

  40. Fethke CC, Smith IM, Johnson N. “Risk” factors affecting readmission of the elderly into the health care system. Med Care. 1986;24:429–37.

    Article  PubMed  CAS  Google Scholar 

  41. Phillips RS, Safran C, Cleary PD, Delbanco TL. Predicting emergency readmissions for patients discharged from the medical service of a teaching hospital. J Gen Intern Med. 1987;2:400–5.

    Article  PubMed  CAS  Google Scholar 

  42. Camberg LC, Smith NE, Beaudet M, Daley J, Cagan M, Thibault G. Discharge destination and repeat hospitalizations. Med Care. 1997;35:756–67.

    Article  PubMed  CAS  Google Scholar 

  43. Weissman JS, Stern RS, Epstein AM. The impact of patient socioeconomic status and other social factors on readmission: a prospective study in four Massachusetts hospitals. Inquiry. 1994;31:163–72.

    PubMed  CAS  Google Scholar 

  44. Williams EI, Fitton F. Factors affecting early unplanned readmission of elderly patients to hospital. BMJ. 1988;297:784–7.

    Article  PubMed  CAS  Google Scholar 

  45. Smith DM, Katz BP, Huster GA, Fitzgerald JF, Martin DK, Freedman JA. Risk factors for nonelective hospital readmissions. J Gen Intern Med. 1996;11:762–4.

    Article  PubMed  CAS  Google Scholar 

  46. Stewart S, Pearson S, Luke CG, Horowitz JD. Effects of home-based intervention on unplanned readmissions and out-of-hospital deaths. J Am Geriatr Soc. 1998;46:174–80.

    PubMed  CAS  Google Scholar 

  47. McNulty BJ. Continuity of care. BMJ. 1973;1:38–9.

    PubMed  CAS  Google Scholar 

  48. Reed RL, Pearlman RA, Buchner DM. Risk factors for early unplanned hospital readmission in the elderly. J Gen Intern Med. 1991;6:223–8.

    Article  PubMed  CAS  Google Scholar 

  49. Burns R. Factors predicting readmission of older general medicine patients. J Gen Intern Med. 1991;6:389–93.

    Article  PubMed  CAS  Google Scholar 

  50. Vinson JM, Rich MW, Sperry JC, Shah AS, McNamara T. Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc. 1990;38:1290–5.

    PubMed  CAS  Google Scholar 

  51. Chin MH, Goldman L. Correlates of early hospital readmission or death in patients with congestive heart failure. Am J Cardiol. 1997;79:1640–4.

    Article  PubMed  CAS  Google Scholar 

  52. Beggs VL, Birkemeyer NJ, Nugent WC, Dacey LJ, O’Connor GT. Factors related to rehospitalization within thirty days of discharge after coronary artery bypass grafting. Best Pract Benchmarking Healthc. 1996;1:180–6.

    PubMed  CAS  Google Scholar 

  53. Gooding J, Jette AM. Hospital readmissions among the elderly. J Am Geriatr Soc. 1985;33:595–601.

    PubMed  CAS  Google Scholar 

  54. Ashton CM, Wray NP. A conceptual framework for the study of early readmission as an indicator of quality of care. Soc Sci Med. 1996;43:1533–41.

    Article  PubMed  CAS  Google Scholar 

  55. Ashton CM, Del Junco DJ, Souchek J, Wray NP, Mansyur CL. The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. Med Care. 1997;35:1044–59.

    Article  PubMed  CAS  Google Scholar 

  56. Weissman JS, Ayanian JZ, Chasan-Taber S, et al. Hospital readmissions and quality of care. Med Care. 1999;37:490–501.

    Article  PubMed  CAS  Google Scholar 

  57. Ludke RL, Booth BM, Lewis-Beck JA. Relationship between early readmission and hospital quality of care indicators. Inquiry. 1993;30:95–103.

    PubMed  CAS  Google Scholar 

  58. Ashton CM, Kuykendall DH, Johnson ML, Wray NP, Wu L. The association between the quality of inpatient care and early readmission. Ann Intern Med. 1995;122:415–21.

    PubMed  CAS  Google Scholar 

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Correspondence to Carl van Walraven MD, FRCPC, MSc.

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van Walraven, C., Seth, R., Austin, P.C. et al. Effect of discharge summary availability during post-discharge visits on hospital readmission. J GEN INTERN MED 17, 186–192 (2002). https://doi.org/10.1046/j.1525-1497.2002.10741.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2002.10741.x

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