Background:
The relationship between a patient and his or her health care providers is fundamental in providing effective care. Studies in ambulatory settings have shown that agreement between patients and their physicians is associated with improved medication adherence and better outcomes. Althhough deficits in patients' understanding of the plan of care in the ambulatory setting and at hospital discharge are well documented, no studies have evaluated patients' understanding of their plan of care during their hospitalization.
Methods:
Interviews of a cross‐sectional sample of patients and their physicians took place in June 2008. Eligible patients included those admitted to 1 of 2 medical services: a house staff–covered teaching service or a non‐house‐staff hospitalist service. Each weekday during the study period, approximately 15 randomly selected patients admitted to these services and their physicians were interviewed in the afternoon of the patient's second hospital day. Patients were asked whether they knew the name of the physician(s) and nurse responsible for their care and specific questions about 6 aspects of their plan of care for the day, including: the main diagnosis, planned tests, procedures, medication changes, which physician consulting services were expected to see them, and the expected length of stay. Patients' responses were recorded verbatim by 1 of 3 trained research assistants. Patients' physicians were interviewed and asked about aspects of the plan of care for the patient in the same fashion as for the patients. Two board‐certified internists reviewed responses and rated patient‐physician agreement on each aspect of the plan of care as none, partial, or complete agreement.
Results:
Of the 250 eligible patients, 241 (96%) agreed to be interviewed. Two hundred and thirty‐three of 241 patients' physicians (97%) completed the interview. Patients correctly named their nurses 60% of the time. Patients correctly named at least 1 of their physicians 32% of the time and their role(s) 11% of the time. For each aspect of care, patients and their physicians lacked complete agreement in a large number of instances. Specifically, there was no agreement between patients and physicians on planned tests or procedures for the day in 38% and 10% of instances, respectively. Complete agreement on the anticipated length of stay occurred only 39% of the time. Results were similar whether patients were admitted to the teaching service or the hospitalist service. Examples of disagreement revealed serious potential consequences, including faulty expectations and questionable ability to provide informed consent.
Conclusions:
Hospitalized patients frequently cannot correctly identify their providers, and a substantial portion of patients do not understand their plan of care. Efforts should be made to improve patients' understanding of their care in order to ensure informed consent and prepare patients to assume their own care after discharge.
Author Disclosure:
K. J. O'Leary, none; N. Kulkarni, none; M. P. Landler, none; J. Jeon, none; K. Hahn, none; K. M. Englert, none; M. V. Williams, none.