PCP Awareness of Patient Hospitalization and Patient Reports of Postdischarge Complications

1University of Chicago, Chicago, IL
2University of Chicago, Chicago, IL
3University of Chicago, Chicago, IL
4University of Chicago, Chicago, IL
5University of Chicago, Chicago, IL
6University of Chicago, Chicago, IL
7University of Chicago, Chicago, IL

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

Abstract number: 78

Background:

Although communication with primary care physicians (PCPs) during patient hospitalization is recommended, it is unclear if this communication is related to patient outcomes. Communication with PCPs may be especially important for frail older adults who are at risk during care transitions. The aim of this study was to assess the association between PCP awareness of patient hospitalization and patient reports of postdischarge complications.

Methods:

Every 10th patient admitted to an inpatient general medicine service at a single academic medical center was invited to participate in this study. Because of interest in experiences of older patients, frail elders were oversampled by inviting every patient who was age 65 and overidentified as a “vulnerable elder” using the VES‐13 screening questionnaire to participate. All eligible patients were asked to participate in a digitally recorded phone interview with a trained research assistant 2 weeks after discharge. At least 3 attempts were made to contact each eligible patient. The critical incident technique was employed to elicit patient reports of postdischarge complications, such as problems with medications, follow‐up appointments, or readmission. Each patient's PCP was faxed a short survey 2 weeks after discharge to assess PCP awareness of the hospitalization. Interview data was analyzed and coded for postdischarge complications and patient perceptions of hospital–PCP communication using the constant comparative method with review by 3 independent investigators. Fisher's exact test was used to test the association between PCP awareness of hospitalization and patient report of a postdischarge complication.

Results:

Sixty‐four patients (53%), mean age 73 years, completed the 2‐week postdischarge phone interview. Forty‐two percent of patients (27) reported 42 different postdischarge complications. The most frequent type of complication was difficulty with follow‐up appointments or tests (12). Other types of complications included readmission and return to the ER (10), problems with medications (8), not prepared for discharge (8), and hospital complications or questions (4). Patient perceptions of hospitalist–PCP communication included uncertainty or confusion (63), assumption that communication occurred (24), or hospital physicians have an obligation to communicate with their PCP (16). PCPs were unaware of hospitalization for 30% of patients. Patients were 2 times more likely to report a complication if their PCP was not aware of hospitalization (31% PCP aware vs. 67% PCP not aware; P = 0.05).

Conclusions:

Many older patients reported experiencing postdischarge complications, especially difficulty with follow‐up appointments or tests. Patients were more likely to report a postdischarge complication when their PCPs were not aware of the hospitalization. Interventions to improve communication with PCPs during hospitalization are needed.

Author Disclosure:

M. Prochaska, none; J. Farnan, none; M. Darcy, none; K, Schwanz, none; D. Meltzer, AHRQ, NIA, NIGMS, Pfizer, Merck, RWJ, PeopleChart, Research Funding, Consultant; J. Johnson, none; V. Arora, AHRQ, NIA, NIGMS, Hartford Foundation, ABIM, research funding, honoraria.

To cite this abstract:

Prochaska M, Farnan J, D'Arcy M, Schwanz K, Meltzer D, Johnson J, Arora V. PCP Awareness of Patient Hospitalization and Patient Reports of Postdischarge Complications. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 78. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/pcp-awareness-of-patient-hospitalization-and-patient-reports-of-postdischarge-complications/. Accessed May 27, 2019.

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