Dismissal disagreement and discharge delays: Associations of patient-clinician plan of care agreement with discharge outcomes.

Autor: Olson EM; Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Falde SD; Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA., Wegehaupt AK; Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Polley E; Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA., Halvorsen AJ; Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Lawson DK; Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.; Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA.; Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA., Ratelle JT; Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.; Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA.
Jazyk: angličtina
Zdroj: Journal of hospital medicine [J Hosp Med] 2022 Sep; Vol. 17 (9), pp. 710-718. Date of Electronic Publication: 2022 Aug 09.
DOI: 10.1002/jhm.12929
Abstrakt: Background: Many hospitalized patients do not understand or agree with their clinicians about their discharge plan. However, the effect of disagreement on discharge outcomes is unknown.
Objective: To measure the correlation between patient-clinician care agreement and discharge outcomes.
Design: A prospective cohort study was performed from September 2019 to March 2020 (Rochester, MN, USA).
Setting and Participants: Internal medicine patients and their primary clinician (resident, advanced practice clinician or attending) hospitalized from September 2019-March 2020 at Mayo Clinic Hospital. Participants were independently surveyed following hospital day #3 ward rounds regarding the goals of the hospitalization and discharge planning.
Main Outcome and Measures: Patient-clinician agreement for main diagnosis, patient's main concern, and four domains of discharge planning was assessed. Readiness for hospital discharge, delayed discharge, and 30-day readmission was measured. Then, associations between patient-clinician agreement, delayed discharge, and 30-day readmissions were analyzed using multivariable logistic regression.
Results: Of the 436 patients and clinicians, 17.7% completely agreed about what needs to be accomplished before dismissal, 40.8% agreed regarding discharge date, and 71.1% agreed regarding discharge location. In the multivariable model, patient-clinician agreement scores were not significantly correlated with discharge outcomes. Patient-clinician agreement on discharge location was higher for those discharged to home (81.5%) versus skilled nursing facility (48.5%) or assisted living (42.9%) (p < .0001). The agreement on the expected length of stay was highest for home-goers (45.9%) compared to skilled nursing (32.0%) or assisted living (21.4%) (p = .004).
Conclusions: Patients and their clinicians frequently disagree about when and where a patient will go after hospitalization, particularly for those discharged to a skilled nursing facility. While disagreement did not predict discharge outcomes, our findings suggest opportunities to improve effective communication and promote shared mental models regarding discharge earlier in the hospital stay.
(© 2022 Society of Hospital Medicine.)
Databáze: MEDLINE
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