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Patient and physician perceptions after software-assisted hospital discharge: cluster randomized trial
James F Graumlich1, Nancy L Novotny, G Stephen Nace
1Department of Medicine, University of Illinois College of Medicine and OSF-Saint Francis Medical Center, Peoria, Illinois, USA. jfg@uic.edu
Background:
Hospital discharge software potentially improves communication and clinical outcomes.
Objective:
To measure patient and physician perceptions after discharge with computerized physician order entry (CPOE) software.
Design:
Cluster randomized controlled trial.
Setting:
Tertiary care, teaching hospital in central Illinois.
Patients:
A total of 631 inpatients discharged to home with high risk for readmission.
Intervention:
A total of 70 internal medicine hospital physicians randomly assigned (allocation concealed) to discharge software vs. usual care, handwritten discharge.
Measurements:
Discharge perceptions from patients, outpatient primary care physicians, and hospital physicians.
Results:
One week after discharge, 92.4% (583/631) of patients answered interviews. For 78.6% (496/631) of patients, their outpatient physicians returned questionnaires 19 days (median) postdischarge. Generalized estimating equations gave intervention variable coefficients with 95% confidence intervals (CIs). When comparing patients assigned to discharge software vs. usual care, patient mean (standard deviation [SD]) scores for discharge preparedness were higher (17.7 [4.1] vs. 17.2 [4.0]; coefficient = 0.147; 95% CI = 0.005-0.289; P = 0.042), patient scores for satisfaction with medication information were unchanged (12.3 [4.8] vs. 12.1 [4.6]; coefficient = -0.212; 95% CI = -0.937-0.513; P = 0.567), and their outpatient physicians scored higher quality discharge (17.2 [3.8] vs. 16.5 [3.9]; coefficient = 0.133; 95% CI = 0.015-0.251; P = 0.027). Hospital physicians found mean effort to use discharge software was more difficult than the usual care (6.5 [1.9] vs. 7.9 [2.1]; P = 0.011).
Conclusions:
Discharge software with CPOE caused small improvements in discharge perceptions by patients and their outpatient physicians. These small improvements might balance the difficulty perceived by hospital physicians who used discharge software.
