Evaluation of a Post-Discharge Follow-Up Process on Patient Care in the Primary Care Clinic: A Pilot Study
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Objective: To evaluate the effectiveness of a post-discharge telephone follow-up process that assesses the recovery status of patients recently discharged from the hospital or evaluated in the ER and transfers care from the hospital to the primary care provider. Study Design: This study is an impact evaluation comparing patterns in primary care provider follow-up time, patient satisfaction and clinician satisfaction from three months prior to implementation to three months after implementation of a standardized post-discharge follow-up protocol. The protocol was implemented within four direct practice primary care clinics throughout the greater Seattle area. The primary participants in this study were a convenience sample of patients who had visited an ER or been hospitalized during the test period. The intervention was a follow-up telephone call, performed by an RN or medical assistant, made to patients recently discharged from a hospital or ER. Methods: Quantitative measures of follow-up care included the number of elapsed days between the patient's hospital discharge and follow-up with the primary care provider between the pre- and post-evaluation phases, the number of repeat emergency room visits, number of hospital readmissions. Patient satisfaction data were collected via surveys to quantitatively measure overall satisfaction with the follow-up care they received from their primary care provider following a hospitalization or ER visit. Clinician satisfaction data were collected from semi-structured group interviews with clinicians regarding hospital follow-up processes before and after implementation of the standardized protocol. Results: No significant change in overall mean and median PCP follow-up time was detected but the variation in follow-up time (in days) decreased in the post-protocol implementation period. During the pre-protocol period, the mean time to follow up with patients after discharge from the ER or hospital was 5.41 days and post-protocol showed a slight decrease to 4.76 days. Median follow-up time remained steady at 3 days between both testing periods. The post-protocol period also showed an increase in hospital readmissions from 4 to 8 and a decrease in repeat ER visits from 9 to 5 since the pre-protocol period. Patient satisfaction appeared to increase between the pre- and post-test periods but due to a low survey response rate, further research is needed to confirm the reliability of these data.
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