Using a Resident Discharge Clinic for Resident Education and Patient Care: A Feasibility Study

Abstract

The RDC was easily implemented, increased access to timely posthospitalization follow-up, and provided a platform for resident learning about care transitions.

Effect of Pharmacy-Supported Transition-of-Care Interventions on 30-Day Readmissions: A Systematic Review and Meta-analysis

“…Of the 2611 citations reviewed, 56 studies 38,39,44-97 were included in the systematic review, and 32 of those studies were analyzed in the meta-analysis. 38,44…”

“…Δs, high number of medication changes at discharge; ↑#Meds., high number of medications at discharge or polypharmacy as defined by each study; MRPs, medication-related problems; Multiple, patients had to have more than 1 chronic disease state; Self-mgmt. concerns, patients who may have a difficult time self-managing their medical conditions or medications; TOC, transition of care; X, no specific patient population was reported in the study. a Patients in each study were required for study inclusion to have one or more of the characteristics listed in the columns of this table unless otherwise specified. b Study results favored the intervention if the study-reported primary outcome was significantly lower compared to usual care. c Other = other targeted population as defined by each study, including the following: admission for stroke or transient ischemic attack; 57,95 abdominal transplant patient; 85 patients on medication(s) for dementia or patients at risk of developing dementia defined as cognitive impairment, sensory impairment, or dehydration; 86 diagnosis of HIV or pneumonia; 96 patients with Medicaid insurance; 58 patients with a consult to the infectious disease service; 59 patients discharged to medical resident clinic; 47 patients with low income and/or uninsured; 38 patients with complex medication regimens; 54 diagnosis of cardiac arrhythmia, major orthopedic surgery, or fracture; 93 patients with Medicare insurance. 68,71 d Patients were required to meet all listed population characteristics for study inclusion. e This patient characteristic was prioritized; there were no exclusion criteria. f Study results were positively trending in favor of the intervention when no P value was reported, but the study-reported primary outcome was lower compared with usual care. g Study results were no different if the study-reported primary outcome was not significantly different between intervention and usual care groups. h Patients whose index admission was a readmission. i Kidney transplant recipients only. j Patients were required to meet one or more listed population characteristics for a total of 10 points for study inclusion. k Study results were not reported in a manner such that statistical significance or trends for the primary outcome could be interpreted. …”

Residents' Exposure to Educational Experiences in Facilitating Hospital Discharges

“…Our study found that only interventions that connected residents with patients after discharge had a significant correlation with their perceived responsibility. The literature contains examples of curricula that connect learners with patients after discharge through telephone calls, clinic visits, or home visits, [28][29][30] yet our results indicate that these experiences are not widely used in IM programs. As residency programs seek to build their transitional care curricula, our results suggest that some aspect of patient follow-up may maximize the impact on residents' perceived responsibility for patients across the care continuum.…”

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

“…Two of the 49 studies described hospital follow-up visit programs in residency clinics. 44,45 Two other studies reported on resident-driven quality improvement projects that addressed communication during the inpatient-outpatient transition. 46,47 None of these studies showed significant reductions in 30-day readmission rates; however, improvements in resident skills, knowledge, and confidence were noted, and the interventions were well-received.…”