Key result
Computerized physician order entry discharge software improved patient discharge preparedness scores compared to usual care (17.7 vs 17.2; P=0.042), despite being perceived as more difficult to use.
Why the study?
Does computerized physician order entry (CPOE) discharge software improve discharge perceptions among patients at high risk for readmission and their physicians?
RCT (n=631)
Cluster randomized
No
Does computerized physician order entry (CPOE) discharge software improve discharge perceptions among patients at high risk for readmission and their physicians?
Effect estimate: coefficient 0.147 (95% CI 0.005-0.289)
Absolute Event Rate: 17.7% vs 17.2%
p-value: p=0.042
CPOE discharge software leads to small improvements in discharge preparedness perceptions by patients and outpatient physicians, despite being perceived as more difficult to use by hospital physicians.
May support cautious CPOE discharge tool adoption in high-risk patients; extends RCT evidence on digital discharge interventions despite usability barriers.
BACKGROUND: Hospital discharge software potentially improves communication and clinical outcomes. OBJECTIVE: To measure patient and physician perceptions after discharge with computerized physician order entry (CPOE) software. DESIGN: Cluster randomized controlled trial. SETTING: Tertiary care, teaching hospital in central Illinois. PATIENTS: A total of 631 inpatients discharged to home with high risk for readmission. INTERVENTION: A total of 70 internal medicine hospital physicians randomly assigned (allocation concealed) to discharge software vs. usual care, handwritten discharge. MEASUREMENTS: Discharge perceptions from patients, outpatient primary care physicians, and hospital physicians. RESULTS: One week after discharge, 92.4% (583/631) of patients answered interviews. For 78.6% (496/631) of patients, their outpatient physicians returned questionnaires 19 days (median) postdischarge. Generalized estimating equations gave intervention variable coefficients with 95% confidence intervals (CIs). When comparing patients assigned to discharge software vs. usual care, patient mean (standard deviation [SD]) scores for discharge preparedness were higher (17.7 [4.1] vs. 17.2 [4.0]; coefficient = 0.147; 95% CI = 0.005-0.289; P = 0.042), patient scores for satisfaction with medication information were unchanged (12.3 [4.8] vs. 12.1 [4.6]; coefficient = -0.212; 95% CI = -0.937-0.513; P = 0.567), and their outpatient physicians scored higher quality discharge (17.2 [3.8] vs. 16.5 [3.9]; coefficient = 0.133; 95% CI = 0.015-0.251; P = 0.027). Hospital physicians found mean effort to use discharge software was more difficult than the usual care (6.5 [1.9] vs. 7.9 [2.1]; P = 0.011). CONCLUSIONS: Discharge software with CPOE caused small improvements in discharge perceptions by patients and their outpatient physicians. These small improvements might balance the difficulty perceived by hospital physicians who used discharge software.
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Graumlich et al. (2009) conducted an RCT in High risk for hospital readmission (n=631). Computerized physician order entry (CPOE) discharge software vs. Usual care, handwritten discharge was evaluated on Patient discharge preparedness score (coefficient 0.147, 95% CI 0.005-0.289, p=0.042). Computerized physician order entry discharge software improved patient discharge preparedness scores compared to usual care (17.7 vs 17.2; P=0.042), despite being perceived as more difficult to use.
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