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Postdischarge Telephone Calls by Hospitalists as a Transitional Care Strategy
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Postdischarge Telephone Calls by Hospitalists as a Transitional Care Strategy

Sarah A. Stella, MD; Angela Keniston, MSPH; Maria G. Frank, MD; Dan Heppe, MD; Katarzyna Mastalerz, MD; Jason Lones, BA; David Brody, MD; Richard K. Albert, MD; and Marisha Burden, MD
Treating hospitalists effectively identify and efficiently address early postdischarge problems through a single, brief telephone encounter.
Many of the problems we identified were not trivial, and 11% of the patients in whom problems were discovered were referred to the ED or urgent care clinic as a result. The spectrum of problems we discovered is similar to previous studies; however, we identified a larger burden of new or worsening symptoms than in some previous studies describing calls by primary care nurses and unlicensed call center representatives surveying medical patients within a similar time frame.15,20 Although the reason for this difference unclear, it is possible that patients may be more comfortable discussing symptoms with their treating physicians or, conversely, that physicians are better at eliciting such symptoms compared with other types of providers, either because they are physicians and/or because they treated the patients during their hospitalization.

We had theorized that treating hospitalists might be able to accurately predict which patients were likely to experience problems following discharge, but our data did not confirm this supposition. Our results indicate that hospitalists’ predictions are marginally better than chance. However, we found that treating hospitalists were able to independently address the majority of problems they identified during the call without requiring additional managed care resources. Moreover, they were able to do so relatively efficiently (eg, median = 10 minutes per case), perhaps because the treating hospitalist was familiar with the patient and had firsthand knowledge of the discharge plan.

The frequency with which postdischarge problems occur, together with the fact that they are difficult for physicians to predict and often initially unrecognized by patients, suggests that early telephone contact with a healthcare provider after hospital discharge should be considered as a routine practice. Given the relatively high burden of new or worsening symptoms signaling possible deterioration in a patient’s condition, we would also suggest that the provider making the calls should possess the clinical acumen necessary to quickly and effectively evaluate such complaints. Although some of the problems we discovered could likely have been dealt with by allied healthcare providers, many were seemingly addressed more directly and efficiently because of the treating hospitalists’ implicit knowledge of the patient gained during their hospitalization.

Limitations and Strengths

Our study has several limitations. First, it was performed in a single university-affiliated public safety net hospital, such that the results might not be generalizable to other types of institutions and/or other patient populations. Second, because we studied patients who were insured through a managed care program, our patients may have had more resources available to them than would be typical of many patients cared for at a safety net hospital. Third, we did not design our study to compare the effectiveness of postdischarge calls by hospitalists with calls made by other types of healthcare providers or with no intervention, such that we cannot conclude that calls by hospitalists are superior to other strategies. Fourth, although fewer patients who received a hospitalist call were rehospitalized, this result may have been influenced by factors unrelated to the call (eg, patients may have been rehospitalized at the time of the call). Lastly, because our study is not a randomized controlled trial, the results may be confounded by unmeasured differences, such as variable health literacy or self-investment.

Our study also has a number of strengths. First, to our knowledge, it is the first study describing postdischarge telephone follow-up of adult patients by treating hospitalists. Second, we utilized a structured survey that included a “teach-back” style of interaction in order to facilitate patient learning and retention of information, and this may have aided our ability to detect and address patients’ problems. Third, we utilized a second call to evaluate patients’ perspectives regarding the usefulness of the call made by the hospitalists.

CONCLUSIONS

Our strategy represents a feasible method of detecting and alleviating early postdischarge problems, which, if unaddressed, may result in poor outcomes. Managed care organizations might consider partnering with hospitalists to enhance the postdischarge safety of their members. To determine whether our approach results in better outcomes than what can be achieved by calls from providers not involved in the care of the patients during their hospitalization would require a prospective randomized trial. Given the potential for improved outcomes, the results of such a trial could substantially alter the customary approach to patient care after discharge.

Author Affiliations: Division of Hospital Medicine (SAS, MGF, DH, MB) and Department of Medicine (SAS, AK, MGF, DH, MB), Denver Health, Denver, CO; Denver Health Managed Care (DB), Denver, CO; University of Colorado School of Medicine (SAS, MGF, DH, KM, DB, RKA, MB), Aurora, CO; Metro Hospitalists, Presbyterian St. Luke’s Medical Center (KM), Denver, CO; Rocky Mountain Poison and Drug Center (JL), Denver, CO.

Source of Funding: This study was unfunded; however we did provide some of the study data to the Colorado Hospital Association as a part of a secondary grant-funded project.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. At the time of paper’s preparation, the authors’ affiliations were accurate, as shown above; however, Dr Heppe is now affiliated with the Department of Veterans Affairs Medical Center in the Eastern Colorado Health Care System.

Authorship Information: Concept and design (RKA, DB, MB, AK, JL, SAS); acquisition of data (MB, MGF, DH, JL, KM, SAS); analysis and interpretation of data (RKA, MB, AK, JL, SAS); drafting of the manuscript (RKA, MB, AK, JL, SAS); critical revision of the manuscript for important intellectual content (RKA, DB, MB, MGF, DH, AK, KM); statistical analysis (RKA, AK, SAS); provision of patients or study materials (DB, DH); administrative, technical, or logistic support (MB, DH, JL, KM, SAS); and supervision (RKA, MB).

Address Correspondence to: Sarah A. Stella, MD, Denver Health and Hospital Authority, 777 Bannock, MC 4000, Denver, CO 80204. E-mail: Sarah.Stella@dhha.org.
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