Rehospitalizations among Medicare beneficiaries are prevalent and costly.

S THE SPECIALTY OF HOSPItal medicine expands, the transfer of responsibility for p a t i e n t c a r e b e t w e e n hospital-based physicians (hospitalists) and primary care physicians becomes increasingly common, creating an urgent need to improve communication and information transfer between inpatient and outp a t i e n t p h y s i c i a n s a t h o s p i t a l discharge. [1][2][3] Timely transfer of accurate, relevant data about diagnostic findings, treatment, complications, consultations, tests pending at discharge, and arrangements for postdischarge follow-up may improve the continuity of this handoff. 4,5 By contrast, delayed communication or inaccuracies in information transfer among health care professionals, particularly during the early postdischarge period, may have substantial implications for continuity of care, patient safety, patient and clinician satisfaction, and resource use. [6][7][8][9][10] The discharge summary is the most common method for documenting a patient's diagnostic findings, hospital management, and arrangements for postdischarge follow-up. The Joint Context Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events. Objectives To characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process. Data Sources MEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies.Study Selection Observational studies investigating communication and information transfer at hospital discharge (n=55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n=18). Data ExtractionData from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer.Data Synthesis Direct communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information im...

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Inadequate functional health literacy poses a major barrier to educating patients with chronic diseases, and current efforts to overcome this appear unsuccessful.