Using Post-discharge Home Visitation to Improve Cultural Sensitivity and Patient-centered Discharge Planning by Internal Medicine Trainees.

BACKGROUND: Patient-centered discharge planning improves transitional care and health outcomes for vulnerable adults. The HOME Initiative was an educational intervention aiming to improve trainees' patient-centered discharge planning skills. METHODS: Using a quasi-experimental design, 52 internal medicine residents at an academic medical center were randomized to intervention or control in 2014-2015. Intervention interns visited recently discharged patients during inpatient rotations. Interns addressed patient deficits in understanding, rectified medication errors, and provided health education. RESULTS: Over three-quarters (77%) of intervention interns completed pre-and post-tests. Intervention interns reported significant improvements in patient-centered discharge planning skills and delivery of culturally sensitive care. Through improved communication skills, residents more effectively elicited patients' illness narratives and assessed their patients' safety (0.65; p=.05), functional status (0.79; p=.02) and health literacy (0.70; p=.01). CONCLUSION: Structured home visitation with recently discharged patients is a valuable tool for medical residents to learn patient-centered discharge planning and improve delivery of culturally sensitive care.

Salmonella septic sacroiliitis: case report and review.

A 14-year-old girl living on a farm developed Salmonella septic sacroiliitis 3 weeks after eating cake batter. An abnormal magnetic resonance image coupled with Salmonella-positive stool and sacroiliac synovial fluid cultures facilitated the diagnosis. She was successfully treated. Twenty-three other cases of Salmonella sacroiliitis are reviewed and reveal a disease primarily of adolescents with a consistent presentation and favorable treatment response.