Abstract
Background/Aims Inadequate continuity of care puts patients at high risk during transitions from the inpatient to ambulatory setting. Several approaches for improving patient transitions from hospitals to home have been developed, but most require substantial commitments of personnel time. With the adoption of electronic medical records by medical group practices, there may be opportunities to improve the quality of care for patients discharged from hospitals.
Methods We conducted a randomized controlled trial of an HIT-based transitional care intervention in a particularly vulnerable patient population, patients aged 65 and older discharged from hospital to home. In addition to notifying providers about the patient’s recent transition, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations of dose changes and laboratory monitoring of high-risk medications, and reminded the primary care provider’s support staff to schedule a post-hospitalization office visit. Randomization occurred at the time of hospital discharge during a one-year intervention period beginning in August 2010. Alerts were automatically delivered to the provider and staff in-basket within the Epic electronic medical record. The primary outcomes were: 1) having an outpatient office visit with the primary care provider within 30 days following discharge, and 2) having a rehospitalization within 30 days following discharge.
Results The study included 3667 discharges of which 1877 discharges were randomly assigned to the intervention arm. Forty-nine percent of discharges in the intervention arm were followed by office visits with the primary care provider within 30 days, compared to 51% in the comparison arm (RR 0.96, 95% CI 0.90, 1.03). Eighteen percent of discharges in the intervention arm were followed by a rehospitalization within 30 days compared to 20% in the comparison arm (RR 0.92, 95% CI 0.80, 1.05).
Conclusions The intervention was not effective in increasing the proportion of discharges followed by timely office visits to primary care providers or reducing the proportion with rehospitalization.
