Provider Characteristics, Clinical-Work Processes and Their Relationship to Discharge Summary Quality for Sub-Acute Care Patients
Provider Characteristics, Clinical-Work Processes and Their Relationship to Discharge Summary Quality for Sub-Acute Care Patients
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DOI：
10.1007/s11606-011-1860-0
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发表时间：
2012-01-01
影响因子：
5.7
通讯作者：
Smith, Maureen A.
中科院分区：
文献类型：
--
作者：
Kind, Amy J. H.;Thorpe, Carolyn T.;Smith, Maureen A.
出院摘要在亚急性护理机构出院患者的过渡性护理中起着关键作用，但促进文件完整性/质量的最佳方法仍然未知。检查临床工作流程、提供者特征和出院总结内容之间的关系，以确定促进高质量出院文件的方法。回顾性队列研究。2003-2005年间，所有从中西部一家大型学术医疗中心出院到亚急性护理机构的髋部骨折和中风患者（N = 489）。接受临终关怀/舒适护理的患者被排除在外。我们从样本患者的出院总结中提取了32个专家推荐的组成部分，分为四类（“患者的医疗过程”、“出院时的功能/认知能力”、“未来护理计划”和“姓名/联系信息”）。我们使用泊松回归模型检查了每个类别中包含的成分数量的预测因子。预测因素包括工作流程（与出院日相关的文件完成情况；完成时间）和提供者特征（培训年份；专业）。历史成分（即“患者的医疗过程”类别）比直接告知亚急性护理机构住院命令的成分（即“未来护理计划”）更常被包括在内。在后一类中，大多数摘要包括出院药物清单（99%）、处置（90%）和随访说明（91%），但较少包括饮食（68%）、活动说明（58%）、治疗命令（56%）、与患者/家属的预后/诊断沟通（15%）、代码状态（7%）和待研究（6%）。如果出院后24小时创建出院总结（事故率比= 0.91,95%可信区间= 0.84-0.98）或实习生创建总结（0.90,0.83-0.97），“未来护理计划”成分更有可能被省略。出院总结中的关键成分遗漏是常见的，并且与文件创建延迟和缺乏经验的提供者有关。需要更多的研究来了解出院文件质量对患者/系统结果的影响。
Discharge summaries play a pivotal role in the transitional care of patients discharged to sub-acute care facilities, but the best ways to facilitate document completeness/quality remain unknown.To examine the relationship among clinical-work processes, provider characteristics, and discharge summary content to identify approaches that promote high-quality discharge documentation.Retrospective cohort study.All hip fracture and stroke patients discharged to sub-acute care facilities during 2003-2005 from a large Midwestern academic medical center (N = 489). Patients on hospice/comfort care were excluded.We abstracted 32 expert-recommended components in four categories ('patient's medical course,' 'functional/cognitive ability at discharge,' 'future plan of care,' and 'name/contact information') from the discharge summaries of sample patients. We examined predictors for the number of included components within each category using Poisson regression models. Predictors included work processes (document completion in relation to discharge day; completion time of day) and provider characteristics (training year; specialty).Historical components (i.e., 'patient's medical course' category) were included more often than components that directly inform the admission orders in the sub-acute care facility (i.e., 'future plan of care'). In this latter category, most summaries included a discharge medication list (99%), disposition (90%), and instructions for follow-up (91%), but less frequently included diet (68%), activity instructions (58%), therapy orders (56%), prognosis/diagnosis communication to patient/family (15%), code status (7%), and pending studies (6%). 'Future plan of care' components were more likely to be omitted if a discharge summary was created > 24 h after discharge (incident rate ratio = 0.91, 95% confidence interval = 0.84-0.98) or if an intern created the summary (0.90, 0.83-0.97).Critical component omissions in discharge summaries were common, and were associated with delayed document creation and less experienced providers. More research is needed to understand the impact of discharge documentation quality on patient/system outcomes.