Background:
Patients are vulnerable during care transitions, and adverse patient events occur frequently after hospital discharge. The incidence and impact of such events has primarily been studied at single institutions. We sought to evaluate the incidence of events posthospital discharge and their impact on rehospitalization.
Methods:
We analyzed data prospectively gathered from patients discharged between January 1, 2007, and December 31, 2007, by hospitalists employed by a single hospitalist management company group at 25 community and referral hospitals in 14 states. Within 72 hours of discharge from the hospital to a home environment, patients or their caregivers were contacted by a trained caller using a standardized questionnaire and problem identification and management algorithm. All postdischarge events were recorded and categorized according to predefined criteria. Patients discharged to skilled care facilities, nursing homes, and inpalient rehabilitation were excluded.
Results:
Of 59,150 patients eligible to receive phone calls, 36,979 (62.5%) were successfully contacted. Eighty‐four hundred discrete postdischarge events were recorded: 43.8% were medication related, 40.1% were follow‐up appointment issues, and 16.2% were reports of new or concerning symptoms. Women (OR: 1.09; 95% Cl 1.03–1.14), patients aged 30‐49 (OR: 1.27; 95% Cl 1.19–1.35), and Medicaid beneficiaries (OR: 1.26; 95% Ci 1.16‐1.37) were more likely to report a postdischarge event, whereas Medicare beneficiaries (OR: 0.84; 95% Cl 0.80–0.89) and patients older than age 80 (OR: 0.83; 95% Cl 0.77–0.89) were less likely. Patients who reported any event were more likely to be rehospitalized within 30 days compared with patients who did not (6.1% vs. 5.6%; P = 0.07). Patients who specifically reported a medication event had a significantly higher rehospitalization rate (11.8% vs. 9.8%, P < 0.003). Medicare beneficiaries (OR: 1.48; 95% Cl 1.34–1.63), Medicaid beneficiaries (OR: 2.07; 95% Cl 1.79–2.39), women (OR: 1.13; 95% Cl 1.03–1,23), and patients with hospital lengths of stay exceeding 7 days (OR: 1.50; 95% Cl 1.32–1.71) were all at greater risk for 30‐day rehospitalization.
Conclusions:
Patients discharged to a home environment commonly experience adverse events shortly after hospital discharge, most commonly involving medication issues. Reporting a medication‐related issue after hospital discharge was associated with a higher 30‐day rehospitalization rate. Despite their significantly higher rehospitalization rates, Medicare beneficiaries were less likely to report a postdischarge event, raising the possibility that the elderly underreport significant postdischarge events.
Author Disclosure:
E, Siegal, none; L. Lindquist, none; K. Dickinson, none; M. Williams, Northwestern University School of Medicine, Editor, Journal of Hospital Medicine.