Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom.
Public Health Foundation of India, Delhi, India.
PLoS One. 2020 Apr 15;15(4):e0230438. doi: 10.1371/journal.pone.0230438. eCollection 2020.
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.
To investigate verbal and documented discharge communication for chronic non-communicable disease (NCD) patients.
To explore the relationship between quality of discharge communication and health outcomes.
Prospective study.
Three public hospitals in Himachal Pradesh and Kerala states, India.
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, discharge communication practices and health-seeking behaviour. Logistic regression was used to explore the relationship between quality of discharge communication and health outcomes.
Patient recall and experiences of verbal and documented discharge communication.
Death, hospital readmission and self-reported deterioration of NCD/s.
All patients received discharge notes, predominantly on sheets of paper with basic pre-printed headings (71%) or no structure (19%); 31% of notes contained all 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.
Sub-optimal discharge practices may be compromising continuity and safety of chronic NCD patient care. Structured protocols, documents and training are required to improve discharge communication, healthcare integration and NCD management.
在高收入国家，沟通不畅与不良健康结果有关。然而，在印度和许多其他中低收入国家，出院沟通质量并没有得到太多关注。
调查慢性非传染性疾病（NCD）患者的口头和书面出院沟通情况。
探讨出院沟通质量与健康结果之间的关系。
前瞻性研究。
印度喜马偕尔邦和喀拉拉邦的三家公立医院。
546 名慢性 NCD（慢性呼吸道疾病、心血管疾病或糖尿病）患者。入院、出院时以及五周和十八周随访时，使用经过预试验的问卷，内容包括健康状况、出院沟通实践和就医行为。使用逻辑回归来探索出院沟通质量与健康结果之间的关系。
患者对口头和书面出院沟通的回忆和体验。
死亡、医院再入院和自我报告的 NCD 恶化。
所有患者都收到了出院记录，主要是在纸条上，基本有预印的标题（71%）或没有结构（19%）；31%的记录包含了促进连续性护理所需的所有以下信息：诊断、药物信息、生活方式建议和随访说明。患者报告显示，出院咨询中提供的口头信息存在显著差异；50%的患者获得了持续治疗/管理信息，23%的患者获得了生活方式建议。在随访的 18 周内，有 25 名（5%）患者死亡，69 名（13%）患者再次入院，62 名（11%）患者报告他们的慢性 NCD 恶化。在 18 周的随访内，低质量书面出院沟通与死亡（优势比=3.00；95%置信区间 1.27-7.06）以及低质量口头出院沟通与自我报告的慢性 NCD 恶化（优势比=0.46；95%置信区间 0.25-0.83）之间存在显著关联。
出院实践不佳可能会影响慢性 NCD 患者的连续性和安全性。需要结构化的方案、文件和培训来改善出院沟通、医疗整合和 NCD 管理。
