Original Article

CME Article: Retrospective Analysis of the Effect of Postdischarge Telephone Calls by Hospitalists on Improvement of Patient Satisfaction and Readmission Rates

Authors: Mengli Xiao, MS, Catherine A. St. Hill, DVM, PhD, Marc Vacquier, MS, Love Patel, MD, Pamela Mink, PhD, Karl Fernstrom, MPH, Justin Kirven, MD, Jessica Jeruzal, BA, David Beddow, MD

Abstract

Objectives: The influence of postdischarge telephone call interventions preventing hospital readmissions is unclear. A novel approach of the discharging hospitalist providing this intervention may improve overall patient satisfaction. Our objective was to assess the impact of postdischarge telephone calls from discharging hospitalists on readmissions and patients’ ratings of hospital care and hospitalist communication.

Methods: Data were retrospectively collected from patients’ electronic health records at a 167-bed hospital in Fridley, Minnesota and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients were 18 years old or older and diagnosed as having nonpsychiatric conditions. Telephone calls were made by the discharging hospitalist to adult patients discharged to home with or without home care services between February 28, 2015 and February 29, 2016. Multivariate logistic regression models were used to evaluate associations of postdischarge telephone calls with global hospital care rating and hospitalist communication from HCAHPS, and 30-day readmission rates from electronic health records.

Results: Of 4490 eligible patients, 1067 had completed telephone calls (23.8%). The intervention was associated with a statistically significant improvement in the responses to HCAHPS overall hospital rating and HCAHPS doctor communication questions (adjusted odds ratio 1.52, P = 0.04 and adjusted odds ratio 1.56, P = 0.021) that varied by patient age at first admission (P = 0.001 and P = 0.101). With longer inpatient lengths of stay, 30-day readmission rates improved after patients received a postdischarge telephone call, but this outcome was not statistically significant.

Conclusions: This study revealed that postdischarge telephone calls from discharging hospitalists increased patient satisfaction. Further research is needed to understand the causal relationships among the intervention, 30-day hospital readmission rates, and inpatient length of stay.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. JAMA 2011;306:1794-1795.
2. Anhang Price R, Elliott MN, Zaslavsky AM, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014;71:522-554.
3. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013;3:e001570.
4. Phatak A, Prusi R, Ward B, et al. Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education, and postdischarge call-backs (IPITCH Study). J Hosp Med 2016;11:39-44.
5. Kripalani S, Jackson AT, Schnipper JL, et al. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med 2007;2:314-323.
6. Conway PH. Value-driven health care: implications for hospitals and hospitalists. J Hosp Med 2009;4:507-511.
7. Jackson GL, Powers BJ, Chatterjee R, et al. The patient-centered medical home: a systematic review. Ann Intern Med 2013;158:169-178.
8. Bahr SJ, Solverson S, Schlidt A, et al. Integrated literature review of postdischarge telephone calls. West J Nurs Res 2014;36:84-104.
9. Banka G, Edgington S, Kyulo N, et al. Improving patient satisfaction through physician education, feedback, and incentives. J Hosp Med 2015;10:497-502.
10. Mann RK, Siddiqui Z, Kurbanova N, et al. Effect of HCAHPS reporting on patient satisfaction with physician communication. J Hosp Med 2016;11:105-110.
11. Indovina K, Keniston A, Reid M, et al. Real-time patient experience surveys of hospitalized medical patients. J Hosp Med 2016;11:251-256.
12. Pregibon D. Logistic regression diagnostics. Ann Stat 1981;9:705-724.
13. Hosmer DW, Hosmer T, Le Cessie S, et al. A comparison of goodness-of-fit tests for the logistic regression model. Stat Med 1997;16:965-980.
14. Jayakody A, Bryant J, Carey M, et al. Effectiveness of interventions utilising telephone follow up in reducing hospital readmission within 30 days for individuals with chronic disease: a systematic review. BMC Health Serv Res 2016;16:403.
15. Branowicki PM, Vessey JA, Graham DA, et al. Meta-analysis of clinical trials that evaluate the effectiveness of hospital-initiated postdischarge interventions on hospital readmission. J Healthc Qual 2017;39:354-366.
16. O'Leary KJ, Darling TA, Rauworth J, et al. Impact of hospitalist communication-skills training on patient-satisfaction scores. J Hosp Med 2013;8:315-320.
17. Velez VJ, Kaw R, Hu B, et al. Do HCAHPS doctor communication scores reflect the communication skills of the attending on record? A cautionary tale from a tertiary-care medical service. J Hosp Med 2017;12:421-427.
18. Kennedy B, Craig JB, Wetsel M, et al. Three nursing interventions' impact on HCAHPS scores. J Nurs Care Qual 2013;28:327-334.
19. Eggenberger T, Garrison H, Hilton N, et al. Discharge phone calls: using person-centred communication to improve outcomes. J Nurs Manag 2013;21:733-739.
20. Guss DA, Leland H, Castillo EM. The impact of post-discharge patient call back on patient satisfaction in two academic emergency departments. J Emerg Med 2013;44:236-241.
21. Guss DA, Gray S, Castillo EM. The impact of patient telephone call after discharge on
likelihood to recommend in an academic emergency department. J Emerg Med 2014;46:560-566.
22. Chan B, Goldman LE, Sarkar U, et al. The effect of a care transition intervention on the patient experience of older multi-lingual adults in the safety net: results of a randomized controlled trial. J Gen Intern Med 2015;30:1788.
23. Schmocker RK, Stafford LMC, Siy AB, et al. Understanding the determinants of patient satisfaction with surgical care using the Consumer Assessment of Healthcare Providers and Systems surgical care survey (S-CAHPS). Surgery 2015;158:1724-1733.
24. Peck BM. Age-related differences in doctor-patient interaction and patient satisfaction. Curr Gerontol Geriatr Res 2011;137492.
25. Lemley KB, Marks B. Patient satisfaction of young adults in rural clinics: policy implications for nurse practitioner practice. Policy Polit Nurs Pract 2009;10:143-152.
26. Weaver LA, Doran KA. Telephone follow-up after cardiac surgery: facilitating the transition from hospital to home. Am J Nurs 2001;101:2400.
27. Dale J, Caramlau I, Sturt J, et al. Telephone peer-delivered intervention for diabetes motivation and support: the telecare exploratory RCT. Patient Educ Couns 2009;75:91-98.
28. Smith DM, Weinberger M, Katz BP, et al. Postdischarge care and readmissions. Med Care 1988;:699-708.
29. Lindquist LA, Yamahiro A, Garrett A, et al. Primary care physician communication at hospital discharge reduces medication discrepancies. J Hosp Med 2013;8:672-677.
30. Manary MP, Boulding W, Staelin R, et al. The patient experience and health outcomes. N Engl J Med 2013;368:201-203.
31. Burke RE, Whitfield E, Prochazka AV. Effect of a hospitalist-run postdischarge clinic on outcomes. J Hosp Med 2014;9:7-12.
32. Ottenbacher KJ, Karmarkar A, Graham JE, et al. Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients. JAMA 2014;311:604-614.
33. Burgess D, van Ryn M, Dovidio J, et al. Reducing racial bias among health care providers: lessons from social-cognitive psychology. J Gen Intern Med 2007;22:882-887.
34. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017;18:19.
35. Weinberger M, Oddone EZ, Henderson WG. Does increased access to primary care reduce hospital readmissions? N Engl J Med 1996;334:1441-1447.
36. Elliott MN, Edwards C, Angeles J, et al. Patterns of unit and item nonresponse in the CAHPS® Hospital Survey. Health Serv Res 2005;40:2096-2119.