New research from the Boston University School of Medicine (BUSM) suggests internal medicine residents who visited patient in their homes after hospital visits can better assess needs. The visits also emphasized the role community services and agencies play in avoiding readmissions.
Results of the study were posted in Gerontology & Geriatrics Education.
“Our intervention enhanced internal medicine residents’ awareness of key components of successful post-discharge care,” wrote lead author Megan Young, MD, assistant professor of medicine at BUSM, and colleagues. “These components include an emphasis on communication among providers, patients and their caregiver; the importance of ensuring discharge plans are feasible given patients’ individual needs and home lives; the value of a multi-disciplinary approach to patient care that includes consideration of psycho-social as well as physical needs; and, albeit to a lesser extent, the benefits of medication reconciliation.”
A group of 39 second- and third-year internal medicine residents from Boston Medical Center (BMC) participated in post-hospital discharge home visits with elderly patients. The visits lasted between 60 and 90 minutes. The residents were able to review and determine the efficacy of the patient’s discharge plan, while identifying the effectiveness of different aspects.
The residents learned, by visiting the homes of the patients, they could assess patient needs. Chiefly, they found patients needed individualized discharge plans that took into consideration communication or health literacy, “context-appropriate” or individualized care, and medication reconciliation.
“We believe that this exercise had an educational impact on participants because they were able to analyze discharge plans of patients they personally had cared for in the hospital,” Young and colleagues wrote. “This continuity of care across transitions provided residents the opportunity to engage in clinical decision making required at each step of care planning, even if they were not the clinicians responsible for actual discharge planning for the patient.”
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.