Features of High Quality Discharge Planning for Patients Following Acute Myocardial Infarction

• Published in: Journal of general internal medicine : JGIM 2013-03, Vol.28 (3), p.436-443
• Main Authors: Cherlin, Emily J., Curry, Leslie A., Thompson, Jennifer W., Greysen, S. Ryan, Spatz, Erica, Krumholz, Harlan M., Bradley, Elizabeth H.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Case Management - organization & administration; Case Management - standards; Coronary heart disease; Epidemiology; Family; General aspects; Health Education - organization & administration; Heart; Heart attacks; Humans; Interinstitutional Relations; Internal Medicine; Long-Term Care - organization & administration; Long-Term Care - standards; Medical sciences; Medicine; Medicine & Public Health; Myocardial Infarction - mortality; Myocardial Infarction - rehabilitation; Original Research; Patient Admission; Patient admissions; Patient Care Team - organization & administration; Patient Care Team - standards; Patient Discharge - standards; Patient Education as Topic - organization & administration; Primary Health Care - organization & administration; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative Research; Quality of Health Care; United States - epidemiology
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-012-2234-y

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.