Background:
Lack of communication and coordination of care after discharge are important factors in hospital readmission. Interventions such as postdischarge phone calls or home visits can improve care transitions, but these approaches are very resource intensive and may be ineffective if performed in isolation. Some core postdischarge health care tasks might be completed or reinforced via the Internet.
Methods:
This was a prospective, national study with surveys administered in person by trained research assistants to readmitted patients at 13 hospitals in the Hospital Medicine Re‐engineering Network (HOMERUN). The full survey contains 27 questions based on validated and study‐specific assessments of readmission risk factors. We analyzed responses to 5 questions about Internet use that were modified from the CDC National Health Interview Survey and the NCI Health Information National Trends Survey (HINTS). We performed descriptive statistics and unadjusted bivariate associations (chi square) with survey questions pertaining to core postdischarge health care tasks: communicating with providers, managing medications, and obtaining follow‐up appointments.
Results:
Preliminary results from 766 patients readmitted within 30 days to 13 hospitals revealed that 513 (67%) had Internet access at home and 377 (49%) had looked up health information within the last year. Use of the Internet to perform 1 of 3 core health care tasks within the last year was much lower: One hundred eighty‐three (24%) used the Internet to communicate with a provider about their health, 100 (13%) refilled a prescription online, and 78 (10%) scheduled an appointment with a provider online. In bivariate analyses (Table 1), we did not find an association between patient Internet use to communicate with their provider and knowing how to contact their doctor if needed after discharge (88% vs. 84%; P = 0.22). Similarly, there was no association between patient Internet use to refill prescriptions and ability to manage their medications after discharge (84% vs. 81%; P = 0.50). By contrast, patients who reported using the Internet to schedule an appointment were more likely to report having a follow‐up visit scheduled prior to their readmission (78% vs. 67%; P = 0.04).
Conclusions:
Among readmitted patients, the gap between general Internet use and Internet use specifically for core health care tasks such as communicating with providers, managing prescriptions, or making appointments suggests a possible intervention target. Increasing patient engagement in key postdischarge tasks online via health information technology may help improve some aspects of transitions in care such as scheduling follow‐up care.
