A Pilot Health Information Technology–Based Effort to Increase the Quality of Transitions From Skilled Nursing Facility to Home: Compelling Evidence of High Rate of Adverse Outcomes
| Autor: | Sarah L. Cutrona, Jennifer Tjia, Lawrence Garber, Abir O. Kanaan, Jerry H. Gurwitz, Jennifer L. Donovan, Peggy Preusse, Terry S. Field |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Health information technology Adverse outcomes media_common.quotation_subject Pilot Projects 030204 cardiovascular system & hematology Patient Readmission 03 medical and health sciences 0302 clinical medicine Ambulatory care Nursing Intervention (counseling) Humans Medicine Transitional care Quality (business) 030212 general & internal medicine Adverse effect General Nursing Aged Skilled Nursing Facilities media_common Aged 80 and over business.industry Health Policy Transitional Care General Medicine Patient Discharge Emergency medicine Female Geriatrics and Gerontology Skilled Nursing Facility business Medical Informatics |
| Zdroj: | Journal of the American Medical Directors Association. 17:312-317 |
| ISSN: | 1525-8610 |
| Popis: | Objectives Older adults are often transferred from hospitals to skilled nursing facilities (SNFs) for post-acute care. Patients may be at risk for adverse outcomes after SNF discharges, but little research has focused on this period. Design Assessment of the feasibility of a transitional care intervention based on a combination of manual information transmission and health information technology to provide automated alert messages to primary care physicians and staff; pre-post analysis to assess potential impact. Setting A multispecialty group practice. Participants Adults aged 65 and older, discharged from SNFs to home; comparison group drawn from SNF discharges during the previous 1.5 years, matched on facility, patient age, and sex. Measurements For the pre-post analysis, we tracked rehospitalization within 30 days after discharge and adverse drug events within 45 days. Results The intervention was developed and implemented with manual transmission of information between 8 SNFs and the group practice followed by entry into the electronic health record. The process required a 5-day delay during which a large portion of the adverse events occurred. Over a 1-year period, automated alert messages were delivered to physicians and staff for the 313 eligible patients discharged from the 8 SNFs to home. We compared outcomes to those of individually matched discharges from the previous 1.5 years and found similar percentages with 30-day rehospitalizations (31% vs 30%, adjusted HR 1.06, 95% CI 0.80–1.4). Within the adverse drug event (ADE) study, 30% of the discharges during the intervention period and 30% of matched discharges had ADEs within 45 days. Conclusion Older adults discharged from SNFs are at high risk of adverse outcomes immediately following discharge. Simply providing alerts to outpatient physicians, especially if delivered multiple days after discharge, is unlikely to have any impact on reducing these rates. |
| Databáze: | OpenAIRE |
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