Table 3

Description of study outcomes and corresponding results

Study: authors, country (year)Outcomes of interestResults
Afilalo et al, Canada (2007)6;Lang et al, Canada (2006)7Readmission, timeliness, PCP satisfaction, quality/completeness
  1. Readmission to emergency department within 14 days; 28 days

  2. Duplication of diagnostic tests and specialty consultations (2022 questionnaires to PCPs)

  1. NS difference in 14-day readmission (OR 1.10, 95% CI 0.8 to 1.51); NS difference in 28-day readmission (OR 1.01, 95% CI 0.8 to 1.27)

  2. NS difference in duplication of tests (24 vs 22, p=0.93).

PCP satisfaction: a web-based questionnaire was emailed to PCPs 21 days postdischarge (responses dichotomised from original 5-point Likert scale: strongly disagree (0), neutral (3), to strongly agree (5)). Responses 1–3=negative; responses 4, 5=affirmative. Applicable to outcomes 4–9.
  • 4. Timeliness

  • 5. Usefulness of information, completeness

  • 6. Knowledge of patients ED visit

  • 7. Patient management

  • 8. Actions initiated by PCP

  • 9. Higher rate of follow-up visits to PCPs office (ED advised, PCP-initiated or patient-initiated)

  • 4. IG PCPs received information more often (73% vs 49%, OR 3.14, 95% CI 2.6 to 3.79). Also received information more often in 48 h (66% vs 0.5%, p<0.001)

  • 5. IG PCPs found information more useful (59% vs 29%, OR 5.1, 95% CI 3.49 to 7.46), and more comprehensive (72% vs 14%, p<0.001+)

  • 6. IG PCPs had better knowledge of patient ED visit (62% vs 21%, OR 6.28, 95% CI 5.12 to 7.71).

  • 7. IG PCPs felt they could better manage patients (45% vs 25% OR 2.46, 95% CI 2.02 to 2.99)

  • 8. IG PCPs initiated more follow-up actions upon information receipt

  • 9. NS increase in patient follow-up visits after ED care (17% vs 14%, OR 1.25, 95% CI 0.97 to 1.61)

García-Aymerich et al, Spain (2007)17Patient satisfaction (self-management/understanding)
  1. Patient satisfaction: self-management/knowledge (name of disease, identification of exacerbation, early treatment of chronic obstructive pulmonary disease exacerbation), Adherence to oral treatment (MAS Scale), adherence to inhaled treatment (IAS Scale), correct inhaler manoeuvre, long term oxygen therapy

  1. IG patients significantly improved knowledge of diseaseincluding: name, exacerbation, adherence to inhaled treatment, inhaler manoeuvres. Other outcomes in this category NS.

Casas et al, Spain, Belgium (2006)16Mortality, readmission, resource use
  1. Mortality: mortality at 12 months (from hospital records, family interviews)

  2. Readmission/ED visits: readmission to hospital during 12 month follow-up

  3. Assessment of resource use by nurse at 1, 3, 6, 9, and 12 months

  1. NS difference (12 deaths (19%) IG vs 14 (16%) usual care). Survival without readmission 32 (49%) vs 28 (31%), p=0.03

  2. IG lower rate of rehospitalisation at 12 months (1.5±2.6 vs 2.1±3.1, p=0.033)

  3. NS difference

Gray et al, USA (2000)18Patient/family satisfaction (quality of care), LOS, discharge location
  1. Patient/family satisfaction: quality of care assessed by Picker Institutes Neonatal Intensive Care Family Satisfaction Survey (1–4 months postdischarge)

  1. IG patients/families reported significantly higher satisfaction with overall quality of care and environmental/visitation dimensions. IG did not report higher satisfaction with coordination of care. IG reported fewer problems with quality of care (mean problem score 3% and vs 13%)

Van Walraven et al, Canada (1999)20Timeliness, quality/completeness, PCP and housestaff satisfaction
  1. Timeliness: proportion of admissions for which a discharge summary was created by 4 weeks postdischarge

  2. Timeliness: number of days from patient discharge to summary generation

  3. Quality/completeness: organisation (of 14 items, proportion ofcontent items from chart review reported with a heading or cited in first sentence of paragraph)

  4. Quality/completeness: overall quality (100 mm VAS; 0 indicating worst to 100 indicating best). Stratification by physician type.

  5. Quality/completeness: completeness (21 items, by chart review)

  6. Housestaff questionnaire. Time and burden to complete, rated 0 (worst) to 100 (best). Preference for each method (100 mm VAS, ratings >50 indicated preference for database/IG system)

  1. IG significantly faster generation at 4 weeks postdischarge (79.6% vs or 57%, p<0.001). This difference persisted post-4 weeks

  2. More IG summaries generated within 1 week postdischarge (94.7%, vs 80.2%, p<0.001)

  3. NS difference. IG summaries significantly shorter with headings

  4. NS difference. Stratification by specialty: PCPs rated IG summaries higher on timeliness (ratings 72.2 vs 62.6, p=0.04). Consultants gave lower ratings to IG summaries for quality (64.6 vs 76.2, p=0.02) and completeness. (68.2 vs79.5, p=0.01)

  5. NS difference (mixed results) 15/21 items cited with significantly different frequency between groups. Ten items (discharge diagnosis, medications, follow-up) more common in IG. 5 /21 items (social history, admission diagnosis, hospital consultations, and functional status at discharge) more common in control summaries.

  6. IG summaries significantly faster to complete (65.3 vs 46.3, p=0.007), less of a burden (65.2 vs 43, p=0.002) and preferred over the dictated summaries (p=0.004)

Kirby et al, UK (2006)12Timeliness
  1. Timeliness: time between patient discharge and posting of discharge summary on to PCP accessible computer system

  1. IG summaries significantly less time to produce and post (mean 0 days vs 80 days, range 55–106, p≤0.0001)

Branger et al, Netherlands (1992)15Timeliness and PCP satisfaction
  1. (Before) timeliness: time to receive paper based posted reports (PCP estimate)

  2. (After) timeliness: time between generation and delivery to PCP of electronically generated messages

  3. (After) timeliness: time for PCP to read messages (measured only over 3 of 10 weeks)

  4. (Before/after) other: percentage of laboratory results stored by PCP, Number of transcription errors

  5. (After) PCP satisfaction: satisfaction with intervention 3 months postreceiving electronic messages regarding accuracy, burden to process, speed of reporting, integration into existing computer based patient record (5-Point Likert Scale: useless (0) to very useful (5))

  1. Between 1 and 10 days by post

  2. 91% of reports available at 1 h, remainder at 3 h postgeneration

  3. PCPs read messages between 0 and 48 h after receipt

  4. More IG summaries were stored than control/paper reports, more errors were found in transcribed paper reports (19 compared with 0)

  5. 20/23 PCPs rated electronic communication of admission-discharge report as ≥4/5 with respect to the benefit of this type of communication. 15/23 reported electronic communication has provided more accurate knowledge of the care being delivered to patients. 10/23 PCPs reported less burden to process electronic communications.

Callen et al, Australia (2008)8; Callen et al, Australia (2010)9Quality/completeness
  1. Quality/completeness: presence of data items in appropriate locations (discharge date, additional/other diagnoses, summary of patient progress including treatment, investigations and results, follow-up requirements, discharge medications)

  2. Quality/completeness: comparison of medication transcription error rate between electronic summaries and traditional handwritten summaries

  3. Quality/completeness: comparison of medication documentation quality by level of physician medical training

  1. IG summaries contained more omissions/errors regarding discharge date (OR 0.17, 95% CI 0.09 to 0.31, p<0.05), additional/other diagnoses (OR 0.33, 95% CI 0.15 to 0.89, p<0.05), follow-up requirements (OR 0.96, 95% CI 0.42 to 2.16, p<0.05), discharge medications (OR 0.5, 95% CI 0.20 to 1.26, p<0.05). IG summaries more commonly reported progress including treatment (OR 18.3, 95% CI 3.33 to 100, p<0.05), investigations and results (OR 3.18, 95% CI 0.84 to 12.0, p<0.05)

  2. NS difference: medication omission the most common error type in both summaries

  3. NS difference in error rates by physician medical training level (intern, resident and registrar)

Graumlich et al, USA (2009)10 11Readmission, emergency department visits, adverse events, patient discharge preparedness and satisfaction, physician satisfaction, timeliness
  1. Readmission/ED visits: proportion of patients readmitted at 6 months

  2. Readmission/ED visits: proportion of patients visiting emergency departments at 6 months

  3. Adverse events: proportion of patients experiencing an adverse event related to medical management within 1 month after discharge

  4. Patient discharge preparedness (B-PREPARED questionnaire)

  5. Patient satisfaction (Information About Medicines Scale questionnaire)

  6. Outpatient physician satisfaction (Modified Physician-PREPARED questionnaire)

  7. Timeliness (hospital physician effort to complete, 10-point Likert Scale: very dissatisfied (1) to very satisfied (10)).

  1. NS difference in hospital readmission at 6 months

  2. NS difference in emergency department visits at 6 months

  3. NS difference in proportion of patients experience adverse events

  4. Patient mean scores significantly higher for intervention patients (M=17.7, SD 4.1 vs 17.2, SD 4.0; coefficient=0.147; 95% CI 0.005 to 0.289, p=0.042)

  5. Patient satisfaction scores with medication information similar between groups (M=12.3, SD 4.8 vs 12.1, SD4.6; coefficient=0.212; 95% CI 0.937 to 0.513, p=0.567)

  6. Outpatient physicians reported higher satisfaction with discharge quality of intervention summaries (M=17.2, SD 3.8 vs 16.5, SD 3.9; coefficient=0.133; 95% CI 0.015 to 0.251, p=0.027)

  7. Hospital physician reported significantly greater effort was required to complete intervention summaries (M=6.5, SD 1.9 vs 7.9, SD 2.1, p=0.011)

Maslove et al, Canada (2009)13Mortality/ED visits/readmissions, timeliness, quality/completeness, PCP, housestaff and patient satisfaction
  1. Composite outcome: emergency department visits, readmissions, death at 30 days

  2. PCP satisfaction: overall satisfaction (100 point VAS), quality, completeness, organisation, timeliness

  3. Housetaff satisfaction (100 point VAS): overall satisfaction, ease of use, preparation time

  4. Patient satisfaction: patient understanding –Rates of attendance at outpatient follow-up tests and appointments –Patient satisfaction (Care Transitions Model-3 score (ranging from 0 to 100)

  1. NS differences between groups

  2. NS differences between groups on quality, completeness, organisation, timeliness

  3. NS difference in overall satisfaction –Housestaff found the IG summaries easier to use (mean rating 86.5 vs 49.2; p=0.03); no difference in time burden (mean rating 36.8 vs 55.2; p=0.23)

  4. NS difference in rates of attendance at outpatient follow-up tests and appointments. –No difference in Care Transitions Model-3 scores (patient satisfaction) between groups (80.3 vs 81.2, p=0.81)

O’Leary et al, USA (2009)14
  1. Adverse events/near misses, timeliness, quality/completeness

  2. Adverse events/near misses: PCP perceived

  3. Timeliness: proportion of summaries completed within 3 days postdischarge

  4. Timeliness: PCP rating (5-Point Likert Scale: very dissatisfied (1) to very satisfied (5))

  5. Quality/completeness: proportions of summary elements present (16 elements using custom ‘Discharge Summary Completeness Score’)

  6. Quality/completeness: clarity/readability of summary (5-Point Likert Scale: unintelligible (1) to lucid (5))

  1. IG PCPs perceived that 1 or more of their patients hospitalised in the preceding 6 months sustained a near miss (65.7% vs 52.9%, p=0.008) or a preventable adverse event (40.7% vs 30.2%, p=0.02) due to poor information transfer before implementing IG summaries

  2. Greater proportion of IG summaries completed within 3 days (72.6% vs 59.4%, p=0.05)

  3. Greater physician satisfaction with timeliness of IG summaries 3.34±1.09 vs control summaries 2.59±1.02 (p≤0.001)

  4. 3/16 elements more common in IG summaries: discussion of follow-up issues (52.0% vs 75.8%; p=0.001), pending test results (13.9% vs 46.3%; p<0.001), and information provided to the patient and/or family (85.1% vs 95.8%; p=0.01)

  5. Authors indicate that ‘quality’ (clarity/readability) improved significantly with IG summaries (3.64±0.99 vs 3.04±0.93, p≤0.001)

  • VAS, visual analogue scale.