Help for patients leaving the hospital can keep them from coming back

E-mail | Print | Comments () Posted by Elizabeth Cooney February 2, 2009 05:00 PM

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Going home from the hospital can be confusing for patients. It can also be dangerous if they don't grasp their diagnosis, their medications, or what kind of follow-up appointments they need to keep.

For one in five patients, problems with medications or other complications mean a return trip to the hospital, according to the Agency for Healthcare Research and Quality.

A team at Boston Medical Center devised a program in which nurses used a personalized booklet to teach patients about their conditions, explain the medications they need to take, and arrange appointments with the doctors they need to see. A pharmacist called the patients about two days later to check on their medications.

In a randomized clinical trial of the program, half of about 700 patients got the intensive discharge education plus followup while half got the standard discharge instructions. Patients who got the extra attention were 30 percent less likely to return to the hospital, whether it was a visit to the emergency room or readmission as an inpatient. The results of the study appear in tomorrow's Annals of Internal Medicine.

"The intervention showed a remarkable effect, much more than any of us ever imagined," Dr. Brian Jack, who led the Boston Medical Center team, said in an interview. "If you apply that to 38 million discharges [a year across the country], that's a real lot."

Overall, the program saved $412 per patient, after accounting for the extra time spent by the nurse and pharmacist to go over the patient's plan and medications.

"There are not too many things that improve health and save money," Jack said.

Patricia Rutherford, vice president of the Cambridge-based Institute for Healthcare Improvement, called the study's results "very good news."

"They have hit upon some very important actions that if they were uniformly adopted could significantly help with this problem," she said.

Using a plan that the patient understands, putting it in writing, and bridging gaps between the hospital doctors and the patient's doctor in the community are key factors for success in the handoff between hospital and home, she said.

"First and foremost, it's better care, and second, it's at reduced cost," she said.

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About white coat notes

White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at cconaboy@boston.com. Follow her on Twitter: @cconaboy.

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