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. 2020 Mar;35(3):808-814.
doi: 10.1007/s11606-019-05414-8. Epub 2019 Oct 25.

Patient-Reported Quality of Hospital Discharge Transitions: Results from the SILVER-AMI Study

Bradley G Richards  1 , Alexandra M Hajduk  2 , Julia Perry  3 , Harlan M Krumholz  4   5   6 , Ali M Khan  6   7   8 , Sarwat I Chaudhry  3
Affiliations

Patient-Reported Quality of Hospital Discharge Transitions: Results from the SILVER-AMI Study

Bradley G Richards et al. J Gen Intern Med. 2020 Mar.

Abstract

Background: Transitions from hospital to home in older patients are a high-risk period for adverse outcomes in a population that may have more challenges navigating the healthcare system. There is little information about the association of patient-reported quality of hospital discharge processes with clinical outcomes.

Objectives: We evaluated whether patient-reported quality of hospital discharge processes was associated with emergency department utilization and rehospitalization within 30 days of discharge after hospitalization for acute myocardial infarction (AMI) in older adults.

Design: Multi-center, prospective cohort study.

Patients: The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study was a longitudinal study of 3006 adults age 75 and older hospitalized with AMI recruited from 94 academic and community hospitals from across the USA.

Intervention: N/A MAIN MEASURES: Patients answered a subset of questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Readmissions and emergency department utilization within 30 days of discharge were ascertained through medical record review.

Key results: A total of 2132 patients were included in the study. Patients' median age was 81 years and the response rate to the survey of discharge quality was 87%. Patients who reported being asked about having the help they needed at home were significantly less likely to have emergency room utilization within 30 days of discharge in both the unadjusted (0.65, 95% CI 0.43-0.99) and adjusted (0.65, 95% CI 0.42-0.997) models, though there was no significant association with readmission.

Conclusion: Report of an assessment of help needed at home during hospitalization was associated with lower post-discharge emergency department utilization. Efforts to improve outcomes after hospital discharge in older patients may benefit from greater focus on assessing need of help at home.

Keywords: AMI; older adults; patient-reported quality; readmission; transitions.

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Conflict of interest statement

Dr. Krumholz reports personal fees from UnitedHealth, ownership (with spouse) of Hugo, personal fees from IBM Watson Health, personal fees from Element Science, personal fees from Aetna, contracts from the Centers for Medicare & Medicaid Services, grants from Medtronic and the Food and Drug Administration, grants from Medtronic and Johnson and Johnson, personal fees from Arnold & Porter, personal fees from Ben C. Martin Law Firm, personal fees from Facebook, grants from Shenzhen Center for Health Information, personal fees from National Center for Cardiovascular Diseases, Beijing, outside the submitted work. Dr. Khan reports personal fees and other from Anthem, Inc., other from Iora Health, outside the submitted work. Dr. Chaudhry serves as a reviewer for the CVS Caremark State of Connecticut Clinical Program. All remaining authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Association of HCAHPS measures with risk of ED utilization at 30 days. CI, confidence interval.
Figure 2
Figure 2
Association of HCAHPS measures with risk of rehospitalization at 30 days. CI, confidence interval.
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References

    1. Anderson JL, Adams CD, Antman EM, et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;123:e426–579. - PubMed
    1. Ho PM, Eng MH, Rumsfeld JS, et al. The influence of age on health status outcomes after acute myocardial infarction. Am Heart J. 2008;155:855–61. - PubMed
    1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e146–603. - PMC - PubMed
    1. Brown JR, Conley SM, Niles NW. Predicting Readmission or Death After Acute ST-Elevation Myocardial Infarction. Clin Cardiol. 2013;36:570–5. - PMC - PubMed
    1. Khawaja FJ, Shah ND, Lennon RJ, et al. Factors associated with 30-day readmission rates after percutaneous coronary intervention. Arch Intern Med. 2012;172:112–7. - PMC - PubMed

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