Predictors and Outcomes of Patient Knowledge of Plan of Care in Hospital Medicine: A Quality Improvement Study.
Jt Comm J Qual Patient Saf
; 47(3): 176-184, 2021 03.
Article
em En
| MEDLINE
| ID: mdl-33454235
ABSTRACT
BACKGROUND:
Patient understanding of plan of care is associated with positive outcomes in ambulatory settings. In hospital medicine settings, patient-physician agreement on plan of care (concordance) has been limited and difficult to improve. This study examined the impact of adding a hospitalist to interdisciplinary rounds (IDR) on physician-patient-nurse concordance and the relationship between concordance and outcomes.METHODS:
IDR were conducted by core teams made up of unit-based nurses, a case manager, and a pharmacist. Over time, with cohorting, hospitalists were included in IDR (hospitalist IDR) for some patients assigned to unit-based hospitalists. In developing hospitalist IDR, the researchers emphasized using an IDR checklist, including a patient communication plan. Patient-nurse-physician interviews were used to assess concordance in the domains of diagnosis, tests and procedures, and expected discharge date. Using two-hospitalist review, agreement was rated as none, partial, or complete, and a total concordance score was calculated for each patient in both IDR groups. Multivariate analysis was used to examine the relationship between concordance, IDR type, patient factors, and utilization outcomes.RESULTS:
For 658 patients, the mean concordance score was 11.71 out of a possible 18. There was no difference in concordance between hospitalist and core IDR groups (11.68 vs. 11.84, pâ¯=â¯0.7). Higher total concordance score was associated with lower lengths of stay (p < 0.001) and readmission rates (pâ¯=â¯0.001). Total concordance had a negative association with patient age (pâ¯=â¯0.04).CONCLUSION:
Concordance did not change with IDR type. Higher concordance appears to be related to positive utilization outcomes. Future studies are needed to evaluate potential interventions to improve concordance.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Médicos Hospitalares
/
Visitas de Preceptoria
/
Medicina Hospitalar
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Jt Comm J Qual Patient Saf
Assunto da revista:
SERVICOS DE SAUDE
Ano de publicação:
2021
Tipo de documento:
Article