The impact of discharge letter content on unplanned hospital readmissions within 30 and 90 days in older adults with chronic illness - a mixed methods study.
BMC Geriatr
; 24(1): 591, 2024 Jul 10.
Article
in En
| MEDLINE
| ID: mdl-38987669
ABSTRACT
BACKGROUND:
Care transitions are high-risk processes, especially for people with complex or chronic illness. Discharge letters are an opportunity to provide written information to improve patients' self-management after discharge. The aim of this study is to determine the impact of discharge letter content on unplanned hospital readmissions and self-rated quality of care transitions among patients 60 years of age or older with chronic illness.METHODS:
The study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a "do not resuscitate" statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of "SAFE-D score". Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission.RESULTS:
All discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.CONCLUSIONS:
While written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge. TRIAL REGISTRATION Clinical Trials. giv, NCT02823795, 01/09/2016.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Patient Discharge
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Patient Readmission
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Heart Failure
Limits:
Aged
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Aged80
/
Female
/
Humans
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Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
BMC Geriatr
Journal subject:
GERIATRIA
Year:
2024
Type:
Article
Affiliation country:
Sweden