Key result
Discharge software with CPOE did not significantly affect hospital readmissions within 6 months compared to usual care (37.0% vs 37.8%; P=0.894).
Why the study?
Does a discharge software application of CPOE reduce readmissions, emergency department visits, or adverse events in inpatients discharged to home with high risk for readmission?
RCT (n=631)
Blinded outcome assessment
Cluster randomized
No
Does a discharge software application of CPOE reduce readmissions, emergency department visits, or adverse events in inpatients discharged to home with high risk for readmission?
Effect estimate: coefficient -0.005 (95% CI -0.074 to 0.065)
Absolute Event Rate: 37% vs 37.8%
p-value: p=0.894
The use of a discharge software application of CPOE did not significantly reduce hospital readmissions, emergency department visits, or adverse events compared to handwritten discharge.
Discharge CPOE software confers no readmission benefit; reinforces usual care and leaves open need for more effective interventions.
BACKGROUND: One of the causes of postdischarge adverse events is poor discharge communication between hospital-based physicians, patients, and outpatient physicians. The value of hospital discharge software to improve communication and clinically relevant outcomes is unknown. OBJECTIVE: To measure effects of a discharge software application of computerized physician order entry (CPOE). 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: Seventy internal medicine hospital physicians were randomly assigned (allocation concealed) to discharge software versus usual care, handwritten discharge. MEASUREMENTS: Blinded assessment of patient readmission, emergency department visit, and postdischarge adverse event. RESULTS: A total of 590 (94%) patients provided 6-month follow-up data. Generalized estimating equations gave intervention variable coefficients with 95% confidence interval (CI). When comparing patients assigned to discharge software versus usual care, there was no difference in hospital readmission within 6 months (37.0% versus 37.8%; coefficient -0.005 [95% CI, -0.074 to 0.065]; P = 0.894), emergency department visit within 6 months (35.4% versus 40.6%; coefficient -0.052 [95% CI, -0.115 to 0.011]; P = 0.108), or adverse event within 1 month (7.3% versus 7.3%; coefficient 0.003 [95% CI; -0.037 to 0.043]; P = 0.884). CONCLUSIONS: Discharge software with CPOE did not affect readmissions, emergency department visits, or adverse events after discharge. Future studies should assess other endpoints such as patient perceptions or physician perceptions to see if discharge software has value.
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Graumlich et al. (2009) conducted an RCT in High risk for readmission (n=631). Discharge software application of computerized physician order entry (CPOE) vs. Usual care, handwritten discharge was evaluated on Hospital readmission within 6 months (coefficient -0.005, 95% CI -0.074 to 0.065, p=0.894). Discharge software with CPOE did not significantly affect hospital readmissions within 6 months compared to usual care (37.0% vs 37.8%; P=0.894).
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