Outcome of Patient‐Directed Scheduling of Discharge Appointments after One Year

1University of Michigan, Ann Arbor, Ml
2University of Michigan, Ann Arbor, Ml
3University of Michigan, Ann Arbor, Ml
4University of Michigan, Ann Arbor, Ml
5University of Michigan, Ann Arbor, Ml

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 22

Background:

The transition from hospitalization to ambulatory care can be a stressful and confusing experience for the nearly 10,000 patients who are discharged every year at our institution. The maturation of the hospitalist field has led us to place an increased focus on this highly vulnerable transition period. Our hospitalist group assessed the current process by which our patients receive a follow‐up appointment. At our institution, this appointment is typically given after discharge to the patient, who is notified by mail. Our hospitalist group devised an electronic system that prioritized patient involvement in setting an appointment prior to discharge. In a previous abstract, we showed that our Online Discharge Appointment (ODA) process reduced no‐show rates to follow‐up appointments by approximately 10% with corresponding improved show rates to 70% from a historical 60% control. Appointment cancellations were not affected. Intriguing benefits in reduced ER visits within 3 days and rehospitalization within 14 days were seen as well. We designed a cohort study to evaluate the arrival rate for discharge follow‐up appointments from 4 equivalent general medicine resident services, 2 of which utilized ODA and 2 of which did not. We also looked at ED and rehospitalization data as secondary outcomes. Finally, we maintained the utilization of ODA on our hospitalist service and report data here as a separate positive control.

Methods:

At our institution, 1 of 4 general medicine resident services is on call over a repeating 4‐day cycle. This natural randomization of patients was used to our advantage, where 2 services (A and B) used the ODA discharge appointment process as our intervention arm. The other 2 (C and D) served as our control arm, using the normal discharge process. Pager‐based restriction was employed to limit access to ODA to the appropriate physicians. Widespread utilization of resident assistants, who entered most of these appointments, also helped to standardize the appropriate use of this service. Then over 9 months, across discharges we collected administrative data, which were analyzed.

Results:

Early results across approximately 1000 unique discharges showed preserved improvement when ODA was used (70% show rate) compared with the control (60% show rate). ODA was utilized in 60% of the discharges from services A and B. The remaining 40% of patients and the 5% crossover detected from services C and D were handled on an intention‐to‐treat basis and would weight our study toward the null hypothesis. Our study has just closed, and we will be able to report on the complete arrival rate, 14 day rehospitalization rate, and 3‐day ER return rate once we have collected all the data.

Conclusions:

Early results from our study confirm the hypothesis that involving patients in the scheduling of their appointments leads to a greater show rate and decreased ER utilization and readmission rates.

Author Disclosure:

R. Chang, none; C. Kim, none; K. Bombach, none; L. Rowland, none.

To cite this abstract:

Chang R, Aguirre J, Bom‐bach K, Rowland L, Kim C. Outcome of Patient‐Directed Scheduling of Discharge Appointments after One Year. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 22. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/outcome-of-patientdirected-scheduling-of-discharge-appointments-after-one-year/. Accessed November 18, 2019.

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