Key result
Low-quality documented discharge communication was significantly associated with an increased risk of death within 18 weeks of follow-up compared to higher-quality documentation (AOR 3.00).
Why the study?
Poor discharge communication is linked to negative health outcomes in high-income countries, but its quality and impact on outcomes have received little attention in India and other low- and middle-income nations.
Cohort (n=546)
Yes
Sub-optimal discharge communication practices in Indian public hospitals are significantly associated with increased mortality and self-reported health deterioration in patients with chronic non-communicable diseases.
Answers are grounded in this paper and cite their sources.
May support better discharge documentation in NCD care; hypothesis-generating and should not yet change practice.
OBJECTIVES: Poor discharge communication is associated with negative health outcomes in high-income countries. However, quality of discharge communication has received little attention in India and many other low and middle-income countries. PRIMARY OBJECTIVE: To investigate verbal and documented discharge communication for chronic non-communicable disease (NCD) patients. SECONDARY OBJECTIVE: To explore the relationship between quality of discharge communication and health outcomes. DESIGN: Prospective study. SETTING: Three public hospitals in Himachal Pradesh and Kerala states, India. PARTICIPANTS: 546 chronic NCD (chronic respiratory disease, cardiovascular disease or diabetes) patients. Piloted questionnaires were completed at admission, discharge and five and eighteen-week follow-up covering health status, discharge communication practices and health-seeking behaviour. Logistic regression was used to explore the relationship between quality of discharge communication and health outcomes. PRIMARY: Patient recall and experiences of verbal and documented discharge communication. SECONDARY: Death, hospital readmission and self-reported deterioration of NCD/s. RESULTS: All patients received discharge notes, predominantly on sheets of paper with basic pre-printed headings (71%) or no structure (19%); 31% of notes contained all the following information required for facilitating continuity of care: diagnosis, medication information, lifestyle advice, and follow-up instructions. Patient reports indicated notable variations in verbal information provided during discharge consultations; 50% received ongoing treatment/management information and 23% received lifestyle advice. Within 18 weeks of follow-up, 25 (5%) patients had died, 69 (13%) had been readmitted and 62 (11%) reported that their chronic NCD/s had deteriorated. Significant associations were found between low-quality documented discharge communication and death (AOR = 3.00; 95% CI 1.27,7.06) and low-quality verbal discharge communication and self-reported deterioration of chronic NCD/s (AOR = 0.46; 95% CI 0.25,0.83) within 18-weeks of follow-up. CONCLUSIONS: Sub-optimal discharge practices may be compromising continuity and safety of chronic NCD patient care. Structured protocols, documents and training are required to improve discharge communication, healthcare integration and NCD management.
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Humphries et al. (2020) conducted a cohort in Chronic non-communicable diseases (cardiovascular disease, chronic respiratory disease, diabetes mellitus, or hypertension) (n=546). Low-quality documented discharge communication (0-2 key items) vs. Higher-quality documented discharge communication (3-4 key items) was evaluated on Death within 18 weeks of discharge (AOR 3.00, 95% CI 1.27-7.06, p=0.012). Low-quality documented discharge communication was significantly associated with an increased risk of death within 18 weeks of follow-up compared to higher-quality documentation (AOR 3.00).
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