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Discharge Plan Cuts Hospital Readmissions, Patient Costs

But medication problems persisted in spite of program, study finds

WEDNESDAY, Feb. 4 (HealthDay News) -- Patients who receive detailed after-hospital care instructions are 30 percent less likely to readmitted to the hospital or to visit the emergency department than uninformed patients who've recently been discharged, according to a U.S. study.

It also found that patients who are fully informed about their after-hospital care -- such as how to take their medications and when to make follow-up appointments -- have an average of $412 less in total costs (actual hospitalization costs and estimated outpatient costs) than patients without complete information.

The study examined the effectiveness of the Re-Engineered Hospital Discharge Program (RED), a multi-faceted program to educate patients about their post-hospital care plans. The program was developed by a team at Boston University Medical Center's Department of Family Medicine.

RED includes specially trained nurses who, using a personalized instruction booklet, help patients arrange follow-up appointments, confirm medication routines, and understand their diagnoses. In addition, a pharmacist contacted patients between two and four days after hospital discharge to reinforce the medication plan and answer any questions.

Thirty days after their release from hospitals, the 370 patients in the RED program had 30 percent fewer subsequent emergency visits and hospital readmissions than the 368 patients who weren't in the program. The study also found that 94 percent of patients in the RED group left the hospital with a follow-up appointment with their primary-care physician (compared to 35 percent for patients not in the program), and 91 percent had their discharge information sent to their primary-care physician within 24 hours of leaving the hospital.

But the RED program didn't prevent medication problems from occurring. The study found that 65 percent of RED program patients who completed the medication review with the pharmacist had at least one problem with their drugs. In half of those cases, the pharmacist needed to contact the patient's doctor or take other corrective action.

The study, funded by the U.S. Agency for Healthcare Research and Quality (AHRQ), was published in the Feb. 3 issue of the Annals of Internal Medicine.

Currently, about 20 percent of patients have a complication or adverse event after they're discharged from hospital. Often, this is due to a lack of knowledge about their follow-up care.

"Because a hospital stay can be a confusing and stressful time for patients, it's important that clinicians make sure patients are prepared to leave the hospital understanding the information they need to recover at home. This study shows us that, with some planning, hospitals can better prepare their patients to avoid complications and reduce unnecessary and costly readmissions," AHRQ Director Dr. Carolyn M. Clancy, said in an agency news release.

More information

The U.S. Agency for Healthcare Research and Quality has more about patient safety after hospital discharge.

-- Robert Preidt

SOURCE: U.S. Agency for Healthcare Research and Quality, news release, Feb. 2, 2009

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