Quality of Discharge Practices and Patient Understanding at an Academic Medical Center
Quality of Discharge Practices and Patient Understanding at an Academic Medical Center
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DOI：
10.1001/jamainternmed.2013.9318
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发表时间：
2013-10-14
影响因子：
39
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Horwitz, Leora I.;Moriarty, John P.;Krumholz, Harlan M.
重要性 随着国家日益关注减少再入院，有必要全面评估过渡护理的质量，包括出院实践、患者观点和患者理解。目的从以患者为中心的角度对过渡护理进行多方面评估。设计前瞻性观察队列研究，2009 年 5 月至 2010 年 4 月。地点城市学术医疗中心。参与者 65 岁及以上的患者因急性冠状动脉综合征住院后出院回家，主要结果和措施 出院实践，包括后续预约和患者友好的出院说明；患者对诊断和随访预约的了解；以及患者对出院护理的看法和满意度。 结果 395 名入组患者（符合条件的患者的 66.7%）平均年龄为 77.2 岁。尽管 349 名患者 (95.6%) 表示了解他们住院的原因，但只有 218 名患者 (59.6%) 能够在出院后访谈中准确描述他们的诊断。出院说明通常包括使用通俗语言的注意症状（98.4%）、活动说明（97.3%）和饮食建议（89.7%）；然而，99 份书面住院理由 (26.3%) 并未使用患者可能理解的语言。在 123 名患者 (32.6%) 中，有 54 名患者 (43.9%) 准确地回忆起任一预约的细节。在出院后访谈中，118 名患者 (30.0%) 报告称收到不到 1 天的提前出院通知，246 名患者 (66.1%) 报告称，工作人员在出院前询问他们是否会在家里获得所需的支持。结论和相关性 患者对出院护理质量和自评理解程度的看法较高，出院书面说明通常很全面，但并不始终清晰。然而，后续预约和提前出院计划不足，患者对出院后护理关键方面的了解也很差。患者的看法和书面文件并不能充分反映患者对出院护理的理解。
IMPORTANCE With growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding.OBJECTIVE To conduct a multifaceted evaluation of transitional care from a patient-centered perspective.DESIGN Prospective observational cohort study, May 2009 through April 2010.SETTING Urban, academic medical center.PARTICIPANTS Patients 65 years and older discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia.MAIN OUTCOMES AND MEASURES Discharge practices, including presence of follow-up appointment and patient-friendly discharge instructions; patient understanding of diagnosis and follow-up appointment; and patient perceptions of and satisfaction with discharge care.RESULTS The 395 enrolled patients (66.7% of those eligible) had a mean age of 77.2 years. Although 349 patients (95.6%) reported understanding the reason they had been in the hospital, only 218 patients (59.6%) were able to accurately describe their diagnosis in postdischarge interviews. Discharge instructions routinely included symptoms to watch out for (98.4%), activity instructions (97.3%), and diet advice (89.7%) in lay language; however, 99 written reasons for hospitalization (26.3%) did not use language likely to be intelligible to patients. Of the 123 patients (32.6%) discharged with a scheduled primary care or cardiology appointment, 54 (43.9%) accurately recalled details of either appointment. During postdischarge interviews, 118 patients (30.0%) reported receiving less than 1 day's advance notice of discharge, and 246 (66.1%) reported that staff asked whether they would have the support they needed at home before discharge.CONCLUSIONS AND RELEVANCE Patient perceptions of discharge care quality and self-rated understanding were high, and written discharge instructions were generally comprehensive although not consistently clear. However, follow-up appointments and advance discharge planning were deficient, and patient understanding of key aspects of postdischarge care was poor. Patient perceptions and written documentation do not adequately reflect patient understanding of discharge care.