Table 4. Discharge and follow-up procedures.
| H2H (N=532) |
STAAR (N=55) |
|
|---|---|---|
|
| ||
| For all patients | ||
| All patients (or their caregivers) receive the following in written form at the time of discharge: | ||
| Discharge instructions | 485 (91.3%) | 45 (81.8%) |
| Names, doses, and frequency of all discharge medications | 463 (87.4%) | 42 (76.4%) |
| Educational information about heart failure, when relevant | 385 (72.5%) | 37 (67.3%) |
| Symptoms that prompt an immediate call to a physician or return to hospital | 352 (66.4%) | 33 (60.0%) |
| Educational information about AMI | 348 (65.5%) | 36 (66.7%) |
| Any type of emergency plan1 | 312 (58.8%) | 26 (47.3%) |
| Action plan for heart failure patients for managing changes in condition | 282 (53.1%) | 28 (50.9%) |
| Personal health record | 139 (26.3%) | 23 (41.8%) |
| Discharge summary | 104 (19.6%) | 12 (21.8%) |
| Patients are discharged from the hospital with an outpatient follow-up appointment already arranged | ||
| Never | 20 (3.8%) | 1 (1.8%) |
| Sometimes | 222 (41.9%) | 26 (47.3%) |
| Usually | 233 (44.0%) | 26 (47.3%) |
| Always | 55 (10.4%) | 2 (3.6%) |
| Patients with home health services are provided direct contact information for a specific inpatient physician in case of questions | 249 (47.1%) | 35 (63.6%) |
| Process is in place to ensure outpatient physicians are alerted to the patient's discharge within 48 hours of discharge | 199 (37.6%) | 37 (67.3%)b |
| Proportion of patients for whom a paper or electronic discharge summary is sent directly to the patient's primary MD | ||
| None | 43 (8.1%) | 3 (5.5%) |
| Some | 153 (28.9%) | 14 (25.5%) |
| Most | 200 (37.8%) | 18 (32.7%) |
| All | 133 (25.1%) | 20 (36.4%) |
| Patient's discharge summary typically completed and available for viewing | ||
| Upon discharge | 42 (8.0%) | 5 (9.1%) |
| Within 48 hours of discharge | 222 (42.1%) | 33 (60.0%) |
| Within 7 days | 94 (17.8%) | 10 (18.2%) |
| Within 30 days | 157 (29.7%) | 7 (12.7%) |
| There are no explicit goals or policies defining a time-frame for completing the discharge summary | 13 (2.5%) | 0 |
| Someone in the hospital is assigned to follow up on test results that return after the patient is discharged | 191 (36.2%) | 27 (49.1%) |
| Patients are regularly called after discharge to either follow up on post-discharge needs or to provide additional education | 334 (63.0%) | 38 (69.1%) |
| Home visits are arranged for all or most patients after discharge | 114 (21.5%) | 9 (16.4%) |
| After discharge, patients: | ||
| Receive telemonitoring | ||
| None | 241 (45.5%) | 12 (21.8%)a |
| Some | 265 (50.0%) | 41 (74.6%) |
| Most | 23 (4.3%) | 1 (1.8%) |
| All | 1 (0.2%) | 1 (1.8%) |
| Receive referrals to cardiac rehabilitation | ||
| None | 27 (5.1%) | 4 (7.4%)b |
| Some | 190 (36.0%) | 28 (51.9%) |
| Most | 203 (38.5%) | 17 (31.5%) |
| All | 108 (20.5%) | 5 (9.3%) |
| Are enrolled in chronic disease management programs | ||
| None | 161 (30.4%) | 13 (23.6%) |
| Some | 321 (60.7%) | 34 (61.8%) |
| Most | 41 (7.8%) | 7 (12.7%) |
| All | 6 (1.1%) | 1 (1.8%) |
|
| ||
| For patients transferred to skilled nursing facilities | ||
|
| ||
| Nurse-to-nurse report is always conducted prior to transfer Information always provided to the facility upon discharge | 326 (61.5%) | 22 (40.0%)a |
| Completed discharge summary | 252 (47.6%) | 27 (49.1%) |
| Reconciled medication list | 436 (82.3%) | 46 (83.6%) |
| Medication administration record | 352 (66.4%) | 38 (69.1%) |
| Direct contact number of inpatient treating physician | 180 (34.0%) | 29 (52.7%)b |
Numbers of missing ranged by item from 1 to 4.
a
P-value < 0.01 in unadjusted analysis.
b
P-value < 0.01 in analysis adjusted for census region and ownership type.
1
Indicates hospitals that provide direct contact information for a specific physician in case of emergency and/or any other type of emergency plan.