Among Heart Attack Patients, Questions About Post-Discharge Help Reduce Follow-Up Emergency Department Visits

Older heart attack patients who were asked whether they had help at home before being discharged from the hospital were significantly less likely to make a subsequent emergency department (ED) visit, an AHRQ study published in the Journal of General Internal Medicine found. Transitions from hospital to home are high-risk events, especially for older patients. Researchers studied responses from more than 2,100 patients age 75 and older to questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The survey, developed by the Centers for Medicare & Medicaid Services (CMS) and AHRQ, is used in CMS’ value-based purchasing program. Patients who said they were asked whether they had sufficient help at home were significantly less likely to use the ED within 30 days of discharge. Access the abstract.

Patient-Reported Quality of Hospital Discharge Transitions: Results From the SILVER-AMI Study

Bradley G Richards 1, Alexandra M Hajduk 2, Julia Perry 3, Harlan M Krumholz 4 5 6, Ali M Khan 6 7 8, Sarwat I Chaudhry 3

Affiliations

PMID: 31654359
DOI: 10.1007/s11606-019-05414-8

Abstract

Background: Transitions from hospital to home in older patients are a high-risk period for adverse outcomes in a population that may have more challenges navigating the healthcare system. There is little information about the association of patient-reported quality of hospital discharge processes with clinical outcomes.

Objectives: We evaluated whether patient-reported quality of hospital discharge processes was associated with emergency department utilization and rehospitalization within 30 days of discharge after hospitalization for acute myocardial infarction (AMI) in older adults.

Design: Multi-center, prospective cohort study.

Patients: The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study was a longitudinal study of 3006 adults age 75 and older hospitalized with AMI recruited from 94 academic and community hospitals from across the USA.

Intervention: N/A MAIN MEASURES: Patients answered a subset of questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Readmissions and emergency department utilization within 30 days of discharge were ascertained through medical record review.

Key results: A total of 2132 patients were included in the study. Patients' median age was 81 years and the response rate to the survey of discharge quality was 87%. Patients who reported being asked about having the help they needed at home were significantly less likely to have emergency room utilization within 30 days of discharge in both the unadjusted (0.65, 95% CI 0.43-0.99) and adjusted (0.65, 95% CI 0.42-0.997) models, though there was no significant association with readmission.

Conclusion: Report of an assessment of help needed at home during hospitalization was associated with lower post-discharge emergency department utilization. Efforts to improve outcomes after hospital discharge in older patients may benefit from greater focus on assessing need of help at home.

Keywords: AMI; older adults; patient-reported quality; readmission; transitions.