Older patients may think they understand everything doctors tell them when they are released from the hospital, but a new U.S. study found several gaps in what they remember and areas where instructions could be clearer. Out of nearly 400 patients discharged from a large academic medical center, 96 percent reported knowing why they had been hospitalized, but only about 60 percent could accurately describe their diagnoses, for instance."Patients were very positive, but when we asked them about actual facts, they could not tell us," said Dr. Leora Horwitz, the study's lead author from the Yale School of Medicine in New Haven, Connecticut.
Hospitals are currently looking at ways to reduce the number of people who have to come back for additional care, something the U.S. government and economists say can be prevented to reduce overall health care spending.
For people on Medicare, the government-run health insurance program for the elderly and disabled, hospital readmissions increase spending by an estimated $26 billion per year, according to federal figures. About $17 billion of that is thought to be potentially preventable.
Much focus has been put on hospitals following recommended medical guidelines to reduce readmissions, though there is also some attention toward making sure patients know what to do after they leave the hospital.
Previous studies have looked at what instructions doctors gave to patients and whether patients were satisfied with the overall process of leaving the hospital, but most of that research didn't take into account whether the patients actually understood what doctors told them.
For the new study, Horwitz and her colleagues asked 395 people age 65 and older about their experience after being discharged from Yale-New Haven Hospital between May 2009 and April 2010. They compared those patients' responses to what was written in their medical charts and the instructions they were given when they were released.
"We really wanted to understand - comprehensively - what happens at the time of discharge," Horwitz said.
The majority received instructions that included easy-to-understand language about what symptoms to watch out for and advice about activities and diet, but about a quarter of the instructions used medical jargon to explain the patient's medical condition.
For example, instead of saying the person had a "heart attack," the instructions used the technical term "myocardial infarction." About 35 percent of patients had trouble explaining why they were in the hospital.
What's more, about half of the patients recalled their doctor having scheduled a follow up visit while the medical records showed only about 33 percent actually had one scheduled. Also, less than one third of patients reported being told while hospitalized about their upcoming discharge more than a day in advance. Two-thirds of patients did recall being asked whether they would have the support they needed at home after discharge.
Dr. Karin Rhodes, director of the Center for Emergency Care Policy and Research in the Department Of Emergency Medicine at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, said the results are consistent with her experience.
"I've worked at a number of academic medical centers and the findings didn't surprise me at all," Rhodes said. In a commentary accompanying the new study in JAMA Internal Medicine, Rhodes suggested that hospitals create a team to handle all aspects of patients' discharges. "It's really hard to do it. It's amazingly hard to change big systems but it can be done," she said.
Horwitz and her colleagues also suggest that hospitals use teach-back methods, which would make a patient explain the instructions back to their care provider to make sure the patient understands what was said. "The message for patients should be that there are a few things you should know when going home," Horwitz said, using the National Patient Safety Foundation's "Ask Me 3" campaign as an example.
The "Ask Me 3" campaign recommends patients ask their doctors three questions: What is my main problem? What do I need to do? Why is it important for me to do this?
Rhodes also suggested that patients write down questions as they occur to them and make sure their doctors answer each one before leaving the room. "It's OK to keep asking questions," Horwitz said.
For doctors, she added that it's important to evaluate their practices to make sure they are focused on the patients and not just focused on meeting regulatory benchmarks. "I think it would be helpful to call a few patients and ask the patients the questions we did," Horwitz said.