Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care?

被引:91
作者
VanSuch, Monica
Naessens, James M.
Stroebel, Robert J.
Huddleston, Jeanne M.
Williams, Arthur R.
机构
[1] Mayo Clin & Mayo Fdn, Dept Hlth Sci Res, Div Hlth Care Policy & Res, Mayo Clin Coll Med, Rochester, MN 55905 USA
[2] Mayo Clin & Mayo Fdn, Dept Med, Div Primary Care Internal Med, Mayo Clin Coll Med, Rochester, MN 55905 USA
[3] Mayo Clin & Mayo Fdn, Dept Med, Div Gen Internal Med, Mayo Clin Coll Med, Rochester, MN 55905 USA
来源
QUALITY & SAFETY IN HEALTH CARE | 2006年 / 15卷 / 06期
关键词
D O I
10.1136/qshc.2005.017640
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Most nationally standardised quality measures use widely accepted evidence-based processes as their foundation, but the discharge instruction component of the United States standards of Joint Commission on Accreditation of Healthcare Organizations heart failure core measure appears to be based on expert opinion alone. Objective: To determine whether documentation of compliance with any or all of the six required discharge instructions is correlated with readmissions to hospital or mortality. Research design: A retrospective study at a single tertiary care hospital was conducted on randomly sampled patients hospitalised for heart failure from July 2002 to September 2003. Participants: Applying the Joint Commission on Accreditation of Healthcare Organizations criteria, 782 of 1121 patients were found eligible to receive discharge instructions. Eligibility was determined by age, principal diagnosis codes and discharge status codes. Measures: The primary outcome measures are time to death and time to readmission for heart failure or readmission for any cause and time to death. Results: In all, 68% of patients received all instructions, whereas 6% received no instructions. Patients who received all instructions were significantly less likely to be readmitted for any cause (p = 0.003) and for heart failure (p = 0.035) than those who missed at least one type of instruction. Documentation of discharge instructions is correlated with reduced readmission rates. However, there was no association between documentation of discharge instructions and mortality (p = 0.521). Conclusions: Including discharge instructions among other evidence-based heart failure core measures appears justified.
引用
收藏
页码:414 / 417
页数:4
相关论文
共 13 条
[1]  
AVERILL RF, 2003, ALL PATIENTS REFINED
[2]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[3]   Correlates of early hospital readmission or death in patients with congestive heart failure [J].
Chin, MH ;
Goldman, L .
AMERICAN JOURNAL OF CARDIOLOGY, 1997, 79 (12) :1640-1644
[4]   ADAPTING A CLINICAL COMORBIDITY INDEX FOR USE WITH ICD-9-CM ADMINISTRATIVE DATABASES [J].
DEYO, RA ;
CHERKIN, DC ;
CIOL, MA .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1992, 45 (06) :613-619
[5]   Simple clinical variables are markers of the propensity for readmission in patients hospitalized with heart failure [J].
Harjai, KJ ;
Thompson, HW ;
Turgut, T ;
Shah, M .
AMERICAN JOURNAL OF CARDIOLOGY, 2001, 87 (02) :234-+
[6]   ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary - A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure) [J].
Hunt, SA ;
Baker, DW ;
Chin, MH ;
Cinquegrani, MP ;
Feldman, AM ;
Francis, GS ;
Ganiats, TG ;
Goldstein, S ;
Gregoratos, G ;
Jessup, ML ;
Noble, RJ ;
Packer, M ;
Silver, MA ;
Stevenson, LW ;
Gibbons, RJ ;
Antman, EM ;
Alpert, JS ;
Faxon, DP ;
Fuster, V ;
Gregoratos, G ;
Jacobs, AK ;
Hiratzka, LF ;
Russell, RO ;
Smith, SC .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 38 (07) :2101-2113
[7]  
Jaeschke R., 2002, USERSGUIDES MEDICAL, P187
[8]  
*JOINT COMM AC HEA, 2002, SPEC MAN NAT IMPL HO
[9]   Quality of care for elderly patients hospitalized with heart failure [J].
Krumholz, HM ;
Wang, Y ;
Parent, EM ;
Mockalis, J ;
Petrillo, M ;
Radford, MJ .
ARCHIVES OF INTERNAL MEDICINE, 1997, 157 (19) :2242-2247
[10]   Quality of care for patients hospitalized with heart failure at academic medical centers [J].
Nohria, A ;
Chen, YT ;
Morton, DJ ;
Walsh, R ;
Vlasses, PH ;
Krumholz, HM .
AMERICAN HEART JOURNAL, 1999, 137 (06) :1028-1034