Parikh Payal, Jaisinghani Priya, Kaloth Srivarsha, Konakanchi Anagha, Yanamala Naveena, Kim Sarang
Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA.
Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
J Gen Intern Med. 2025 Apr 23. doi: 10.1007/s11606-025-09510-w.
Safe transitions of care post inpatient hospitalization require robust communication practices during the discharge process to ensure patient understanding.
To determine if physician-led patient communication, inclusive of written and verbal instructions with the teach-back method, improves patient understanding of hospitalization and post-discharge needs.
This pre-post study was piloted at an urban, 600-bed, academic tertiary care hospital over a 3-month period.
Study participants included adult patients admitted to the hospitalist medical teaching service (MTS).
Study participants received both a written summary and verbal instruction reinforced with teach-back method. The instruction included the four core domains of patient education: reason for admission, inpatient management, medication changes, and follow-up plan.
Changes in mean patient understandings scores from pre- to post-intervention were evaluated on a 3-point scale (no, partial, or full understanding) in addition to basic demographics, level of schooling, and primary language spoken to better ascertain the drivers of improved health literacy.
Among 120 study participants, mean survey scores in all four testing domains showed improvement in patient understanding of "admitting diagnosis" (21.5%, 95% CI, 0.21 to 0.40; P < 0.0001), "treatment undergone" (35.1%, 95% CI, 0.34 to 0.58; P < 0.0001), "medication changes" (45.8%, 95% CI, 0.40 to 0.67; P < 0.0001), and "discharge follow-up" (38.1%, 95% CI, 0.39 to 0.63; P < 0.0001). Mean scores improved more in patients with lower levels of schooling in all testing domains, except for "understanding of medication changes," showing more improvement in patients with high education achievement (95% CI, 0.08 to 1.09; P = 0.027).
While standard discharge practice involves only a printed discharge packet, the use of a written summary of instructions and verbal reinforcement using teach-back methods improves patient understanding and health literacy of post-discharge needs during transitions of care.
住院患者出院后的安全护理过渡需要在出院过程中采用强有力的沟通方式，以确保患者理解。
确定由医生主导的患者沟通，包括采用反馈教学法的书面和口头指导，是否能提高患者对住院情况及出院后需求的理解。
这项前后对照研究在一家拥有600张床位的城市学术三级护理医院进行了为期3个月的试点。
研究参与者包括入住医院内科教学服务部（MTS）的成年患者。
研究参与者接受了一份书面总结以及采用反馈教学法强化的口头指导。指导内容包括患者教育的四个核心领域：入院原因、住院治疗、药物变化及后续计划。
除了基本人口统计学信息、受教育程度和主要语言外，还采用3分制（不理解、部分理解或完全理解）评估干预前后患者平均理解得分的变化，以更好地确定健康素养提高的驱动因素。
在120名研究参与者中，所有四个测试领域的平均调查得分显示患者对“入院诊断”（21.5%，95%置信区间，0.21至0.40；P＜0.0001）、“接受的治疗”（35.1%，95%置信区间，0.34至0.58；P＜0.0001）、“药物变化”（45.8%，95%置信区间，0.40至0.67；P＜0.0001）和“出院随访”（38.1%，95%置信区间，0.39至0.63；P＜0.0001）的理解有所改善。在所有测试领域中，受教育程度较低的患者平均得分改善更多，但“对药物变化的理解”除外，该领域中高学历患者的改善更为明显（95%置信区间，0.08至1.09；P = 0.027）。
虽然标准的出院流程仅涉及一份打印的出院资料包，但使用书面指导总结和采用反馈教学法的口头强化能提高患者在护理过渡期间对出院后需求的理解和健康素养。
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