Data from: Discharge communication for chronic disease patients in three hospitals in India

OBJECTIVES Poor discharge communication is associated with negative health
outcomes in high-income countries. However, quality of discharge
communication has received little attention in India and many other low
and middle-income countries. Primary Objective To investigate verbal and
documented discharge communication for chronic non-communicable disease
(NCD) patients. Secondary objective To explore the relationship between
quality of discharge communication and health outcomes. METHODS: Design
Prospective study. Setting: Three public hospitals in Himachal Pradesh and
Kerala states, India. Participants: 546 chronic NCD (chronic respiratory
disease, cardiovascular disease or diabetes) patients. Piloted
questionnaires were completed at admission, discharge and Five and
eighteen-week follow-up covering health status, health-seeking behaviour
and healthcare information exchange practices. Logistic regression was
used to explore the relationship between quality of discharge
communication and health outcomes. Outcome Measures: Primary: Patient
recall and experiences of verbal and documented discharge communication.
Secondary: Death, hospital readmission and self-reported deterioration of
NCD/s. RESULTS All patients received discharge notes, which were
predominantly on minimally structured sheets of paper (71%); 31% of notes
contained all of the following information required for facilitating
continuity of care: diagnosis, medication information, lifestyle advice,
and follow-up instructions. Patient reports indicated notable variations
in verbal information provided during discharge consultations; 50%
received ongoing treatment/management information and 23% received
lifestyle advice. Within 18 weeks of follow-up, 25 (5%) patients had died,
69 (13%) had been readmitted and 62 (11%) reported that their chronic
NCD/s had deteriorated. Significant associations were found between
low-quality documented discharge communication and death (AOR=3.00; 95% CI
1.27,7.06) and low-quality verbal discharge communication and
self-reported deterioration of chronic NCD/s (AOR=0.46; 95% CI 0.25,0.83)
within 18-weeks of follow-up. CONCLUSIONS Sub-optimal discharge practices
may be compromising the continuity and safety of chronic NCD patient care.
Structured protocols, documents and training are required to improve
discharge communication, healthcare integration and overall NCD
management.