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March 25, 2013JAMA Internal Medicine

Association of Self-reported Hospital Discharge Handoffs With 30-Day Readmissions

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Key result

Self-reported direct communication between inpatient and outpatient providers was not associated with 30-day readmissions (OR 1.08; 95% CI 0.92-1.26).

Why the study?

Does direct communication between inpatient and outpatient providers at discharge reduce 30-day readmissions in hospitalized patients?

Population

6,635 hospitalizations for initial visits at a 1000-bed urban, academic center from September 2010 to…

Comparison

Self-reported direct communication between… vs Lack of direct communication between inpatient…

Design

Cohort

Follow-up

30 days

Authors

IOIbironke OduyeboKaiser PermanenteCLChristoph U. LehmannHeidelberg UniversityCPCraig Evan PollackJohns Hopkins University

Discussion

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Overview

Does not support relying on direct communication to reduce readmissions; leaves open whether quality, measurement, or targeted interventions matter.

Key Points

  • To determine how often inpatient clinicians directly contact outpatient providers at hospital discharge and whether these handoffs are associated with reduced 30-day readmission rates.
  • Prospective single-center study analyzing N=6,635 adult hospitalizations across inpatient medical services from September 2010 to December 2011.
  • Self-reported provider communication was collected via mandatory electronic discharge worksheets and linked to administrative records.
  • Multivariable logistic regression evaluated predictors of direct communication and its association with 30-day readmission, controlling for illness severity, demographics, and provider type.
  • Direct inpatient-to-outpatient communication was recorded in 36.7% of hospitalizations (2,438 of 6,635), most often omitted because providers felt the written discharge summary was adequate.
  • Direct handoff communication showed no significant association with 30-day readmissions in adjusted analysis (OR, 1.08 [95% CI, 0.92-1.26]).
  • Direct handoffs were more likely among hospitalists without house staff (OR, 1.81 [95% CI, 1.59-2.08]) and patients with higher predicted 30-day readmission risk (OR, 1.18 [95% CI, 1.10-1.28] per 10%).

Study Design

Type

Observational (n=6,635)

Multicenter

No

Structured PICO

Does direct communication between inpatient and outpatient providers at discharge reduce 30-day readmissions in hospitalized patients?

P
Population
6,635 hospitalizations on inpatient medical services at a single academic center, followed for 30 days to assess readmissions.
E
Exposure
Self-reported direct communication between inpatient and outpatient providers at discharge
C
Comparator
Lack of direct communication between inpatient and outpatient providers at discharge
O
Outcome
30-day readmissionshard clinical

Main Result

Odds Ratio: 1.08 (95% CI 0.92–1.26)

Self-reported direct communication between inpatient and outpatient providers at hospital discharge occurs at a low rate and is not independently associated with a reduction in 30-day readmissions.

Cite This Study

Oduyebo et al. (2013) conducted an observational in Hospital discharge (n=6,635). Direct communication between inpatient and outpatient providers vs. No direct communication was evaluated on 30-day readmission (OR 1.08, 95% CI 0.92-1.26). Self-reported direct communication between inpatient and outpatient providers was not associated with 30-day readmissions (OR 1.08; 95% CI 0.92-1.26).

synapsesocial.com/papers/6a7b84bd8d1d604667ed10echttps://doi.org/10.1001/jamainternmed.2013.3746
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Also Consider

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  1. 1Association of Communication Between Hospital-based Physicians and Primary Care Providers with Patient Outcomes2008 · 157 citations
  2. 2The independent association of provider and information continuity on outcomes after hospital discharge: Implications for hospitalists2010 · 73 citations
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  5. 5Validation of the Potentially Avoidable Hospital Readmission Rate as a Routine Indicator of the Quality of Hospital Care2006 · 262 citations