Investigating discharge communication for chronic disease patients in three hospitals in India

OBJECTIVES: Poor discharge communication is associated with negative health outcomes in high-income countries. However, quality of discharge communication has received little attention in India and many other low and middle-income countries.

PRIMARY OBJECTIVE: To investigate verbal and documented discharge communication for chronic non-communicable disease (NCD) patients.

SECONDARY OBJECTIVE: To explore the relationship between quality of discharge communication and health outcomes.

METHODS:

DESIGN: Prospective study.

SETTING: Three public hospitals in Himachal Pradesh and Kerala states, India.

PARTICIPANTS: 546 chronic NCD (chronic respiratory disease, cardiovascular disease or diabetes) patients. Piloted questionnaires were completed at admission, discharge and five and eighteen-week follow-up covering health status, discharge communication practices and health-seeking behaviour. Logistic regression was used to explore the relationship between quality of discharge communication and health outcomes.

OUTCOME MEASURES:

PRIMARY: Patient recall and experiences of verbal and documented discharge communication.

SECONDARY: Death, hospital readmission and self-reported deterioration of NCD/s.

RESULTS: All patients received discharge notes, predominantly on sheets of paper with basic pre-printed headings (71%) or no structure (19%); 31% of notes contained all the following information required for facilitating continuity of care: diagnosis, medication information, lifestyle advice, and follow-up instructions. Patient reports indicated notable variations in verbal information provided during discharge consultations; 50% received ongoing treatment/management information and 23% received lifestyle advice. Within 18 weeks of follow-up, 25 (5%) patients had died, 69 (13%) had been readmitted and 62 (11%) reported that their chronic NCD/s had deteriorated. Significant associations were found between low-quality documented discharge communication and death (AOR = 3.00; 95% CI 1.27,7.06) and low-quality verbal discharge communication and self-reported deterioration of chronic NCD/s (AOR = 0.46; 95% CI 0.25,0.83) within 18-weeks of follow-up.

CONCLUSIONS: Sub-optimal discharge practices may be compromising continuity and safety of chronic NCD patient care. Structured protocols, documents and training are required to improve discharge communication, healthcare integration and NCD management.