Background: It remains unclear how implementing new technology in the inpatient setting affects patients and providers. MyChart Bedside, a tool that allows patients open access to their health record, was implemented across several inpatient units within the Duke University Health System. Assessing provider and patient perceptions of this new technology is essential to understanding its [...]

Background: Hospitalized older adults are increasingly referred to skilled nursing facilities (SNFs) for post-acute care following hospitalization. However, whether hospitalized older adults are enabled to make high-quality decisions about different post-acute care options is unclear. This is important because a high-quality decision aligned with patient values and expectations may lead to a better match of [...]

Background: Communication has been cited as the most common root cause in sentinel events, with failed patient care handoffs contributing to an estimated 80% of serious preventable adverse events. Handoffs to sub-acute care such as nursing homes are at particularly high risk for communication breakdown given high patient complexity and comorbidity. Our healthcare system includes [...]

Background: With advances in medical care, there is a growing population with childhood-onset chronic health conditions reaching adulthood. A 2011 consensus statement by the AAP, AAFP and ACP identified an algorithm for transition from pediatric to adult care, but change in practice has been slow. The purpose of this study was to better understand the [...]

Background: Patients discharged against medical advice (AMA) have disproportionately high healthcare costs and increased morbidity, mortality, and hospital readmissions. While patient risk factors for discharge AMA are known, there is little data regarding providers’ practice patterns during AMA discharge, including provision of follow-up appointments. Similarly, the frequency of a documented discussion of the risks and [...]

Background: Patients admitted to inpatient hospital services are increasingly cared for by hospitalists rather than their primary care providers. When transitioning from hospital-based to ambulatory care, suboptimal information transfer can lead to serious adverse events and readmissions; therefore, demands for timely preparation of high-quality discharge summaries are increasing. Confronted with these demands, most hospitalists are [...]

Background: Hospital admissions are the majority contributor to the cost in caring for diabetes, accounting for about 40% of the costs. As most hospital reimbursements are based upon diagnosis-related groups, hospitals have strong financial incentives for quicker discharges to control length of stay and costs. This can limit the time available to develop a comprehensive [...]

Background:  Patient care may be enhanced as they transition from one health care setting or provider to another.  However, studies have shown that as many as 1 in 5 patients suffer an adverse event within two weeks of discharge. These events include medication errors or inadequate understanding of disease diagnosis and post-discharge instructions.  Such errors [...]

Background: Patients diagnosed in-hospital with acute venous thromboembolism (VTE) are at high risk for post-discharge complications and readmission similar to patients with chronic conditions. Patient navigation reduces post-discharge complications and readmissions in patients with chronic diseases, however its role in acute conditions is less clear. Similarly, the use of mobile technology to improve patient engagement [...]

Background: National readmission rates for all-cause hospitalizations are as high as 14 readmits per 100 index admissions and have been relatively unchanged for at least the last 5 years (Fingar K, et al. Agency for Health Care Policy and Research, 2015). Since January of 2013, the Centers for Medicare & Medicaid Services has adopted a [...]