Assessment of Patient Retention of Inpatient Care Information Post-Hospitalization.

BACKGROUND: Patient understanding of medical care improves readmission rates and patient satisfaction, yet the literature suggests patients often have poor retention of care information post-hospitalization. Although multiple interventions have been implemented to facilitate this process, the cumulative durability of their benefit remains unclear. The authors conducted this study to more objectively understand how well patients retain care information after hospital discharge and to assess patient perspectives on facilitators of this process (for example, whiteboards and patient portals). METHODS: Semistructured phone interviews of patients admitted to general medicine resident teaching services were performed within 24 to 48 hours post-hospitalization. Recall of four key domains of care (diagnoses addressed, inpatient treatment, postdischarge treatment plans, and medication changes) was elicited. Chart review was performed to verify patient responses. Responses were then categorized by independent reviewers as correct, partially correct, or incorrect. Patient perspectives on facilitators to help with information retention were also assessed. RESULTS: Fifty-three patients participated. The vast majority (> 90%) were confident in their knowledge of their diagnoses and treatment, yet independent review revealed only 58.5%, 64.2%, 50.9%, and 43.4% of patients correctly recalled each respective key domain. Whiteboards were the most frequently used facilitator (96.2%), yet their content was rated least helpful for retaining care information. Patients suggested several areas for improvement, including prioritizing bedside pen and paper along with updating whiteboards with diagnostic and therapeutic information. CONCLUSION: Patient recall of their inpatient care after discharge, despite modern facilitators, remains poor. Further efforts are needed to enhance or implement facilitators based on patient feedback.

Enhancing Resident Education by Embedding Improvement Specialists Into a Quality and Safety Curriculum.

Background: Quality improvement and patient safety (QIPS) curricula are critical in graduate medical education, yet barriers limit the educational experience and project outcomes. Objective: To explore the impact of QIPS curricular enhancements and integration of continuous improvement specialists (CIS) by examining the A3 document, the primary project product and surrogate for project quality. Methods: Since 2009, University of Michigan internal medicine and medicine-pediatric residents participate in a QIPS curriculum, which includes a 4-week group project. In 2016, residency leaders collaborated with CIS staff, non-clinical experts in QIPS with backgrounds in engineering and business, to improve the curriculum. Informed by a needs assessment, the intervention was implemented in 2017 and consisted of a set of enhancements including integration of CIS staff into groups as co-facilitators. In this retrospective cohort study, a blinded reviewer evaluated all available A3 documents before and after the intervention using a quantitative analysis tool. Results: All residents participated in the curriculum during the pre-intervention (July 2009 to June 2016, n=351) and post-intervention (July 2017 to June 2020, n=148) periods. A total of 23 of 84 (27%) pre-intervention and 31 of 34 (91%) post-intervention A3 documents were available for review. Scores improved significantly for 17 of 23 (74%) A3 items and for 7 of 8 (88%) sections. Mean A3 total scores increased from 29.0 to 47.0 (95% CI 12.6-23.4; P<.001) out of a possible 69.0. Conclusions: Embedding CIS experts into residency QIPS curricula is associated with improved A3 document quality.

Ethical Perspectives of Chinese and United States Physicians at Initiation of a Research Collaborative.

Variances in perceived standards regarding research integrity appear to exist between China and the U.S. An established joint institute for translational and clinical research between one Chinese and one U.S. health system provides a valuable venue in which to evaluate these perceptions better. We therefore undertook a survey of 209 physicians at the two institutions in 2013-14. The vast majority of physicians from both institutions understood the necessity of obtaining informed consent from research participants, the need to provide a description of the risks of participation, and the voluntary nature of research participation. However, there were differences in responses between the two sites in willingness to report plagiarism (U.S. 95.65% vs. Chinese 40.21%; p < .0001) and data falsification (U.S. 100% vs. Chinese 81.25%; p < .0001) and in willingness to attend biomedical industry-funded promotional events (U.S. 11.0% vs. Chinese 74.0%; p < .0001). When planning to conduct collaborative clinical research across cultures, particularly when uncertainty regarding the similarity of research cultures exists, exploration of cultural and ethical norms in research may be informative regarding educational needs and the risks of research and academic misconduct.