ABSTRACT
BACKGROUND
Hospital discharge planning is required as a Medicare Condition of Participation (CoP), and is essential to the health and safety for all patients. However, there have been no studies examining specific hospital discharge processes, such as patient education and communication with primary care providers, in relation to hospital 30-day risk standardized mortality rates (RSMRs) for patients with acute myocardial infarction (AMI).
OBJECTIVE
To identify hospital discharge processes that may be associated with better performance in hospital AMI care as measured by RSMR.
DESIGN
We conducted a qualitative study of U.S. Hospitals, which were selected based on their RSMR reported by the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website for the most recent data available (January 1, 2005 – December 31, 2007). We selected hospitals that ranked in the top 5 % and the bottom 5 % of RSMR for the two consecutive years. We focused on hospitals at the extreme ends of the range in RSMR, known as deviant case sampling. We excluded hospitals that did not have the ability to perform percutaneous coronary intervention in order to decrease the heterogeneity in our sample.
PARTICIPANTS
Participants included key hospital clinical and administrative staff most involved in discharge planning for patients admitted with AMI.
METHODS
We conducted 14 site visits and 57 in-depth interviews using a standard discussion guide. We employed a grounded theory approach and used the constant comparative method to generate recurrent and unifying themes.
KEY RESULTS
We identified five broad discharge processes that distinguished higher and lower performing hospitals: 1) initiating discharge planning upon patient admission; 2) using multidisciplinary case management services; 3) ensuring that a follow-up plan is in place prior to discharge; 4) providing focused education sessions for both the patient and family; and 5) contacting the primary care physician regarding the patient’s hospitalization and follow-up care plan.
CONCLUSION
Comprehensive and more intense discharge processes that start on admission continue during the patient’s hospital stay, and follow up with the primary care physician within 2 days post-discharge, may be critical in reducing hospital RSMR for patients with AMI.
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Acknowledgements
Funding and support were provided by the Agency for Healthcare Research and Quality (AHRQ RO1-HS0-16929-1), the United Health Foundation, and the Commonwealth Fund. Dr. Krumholz was supported by grant U01 HL105270-02 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. We thank Yongfei Wang and the Multidisciplinary Team for their research contributions.
Conflict of Interest
Dr. Krumholz discloses that he is the recipient of a research grant from Medtronic, Inc. through Yale University and is chair of a cardiac scientific advisory board for UnitedHealth. All other authors declare that they do not have a conflict of interest.
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Cherlin, E.J., Curry, L.A., Thompson, J.W. et al. Features of High Quality Discharge Planning for Patients Following Acute Myocardial Infarction. J GEN INTERN MED 28, 436–443 (2013). https://doi.org/10.1007/s11606-012-2234-y
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DOI: https://doi.org/10.1007/s11606-012-2234-y