Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity

Author:

Kutz Alexander12,Koch Daniel1,Haubitz Sebastian1,Conca Antoinette1,Baechli Ciril1,Regez Katharina1,Gregoriano Claudia1,Ebrahimi Fahim3,Bassetti Stefano45,Eckstein Jens4,Beer Juerg6,Egloff Michael6,Kaeppeli Andrea7,Ehmann Tobias8,Hoess Claus9,Schaad Heinz10,Wharam James Frank11,Lieberherr Antoine12,Wagner Ulrich13,de Geest Sabina14,Schuetz Philipp15,Mueller Beat15

Affiliation:

1. Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland

2. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

3. Division of Gastroenterology, University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital, Basel, Switzerland

4. Division of Internal Medicine, University Hospital Basel, Basel, Switzerland

5. Faculty of Medicine, University of Basel, Basel, Switzerland

6. Department of Medicine, Cantonal Hospital Baden, Baden, Switzerland

7. Department of Medicine, Hospital Muri, Muri, Switzerland

8. Department of Medicine, Hospital Zofingen, Zofingen, Switzerland

9. Department of Medicine, Cantonal Hospital Muensterlingen, Muensterlingen, Switzerland

10. Department of Medicine, Hospital Interlaken, Hospitals Frutigen Meiringen Interlaken, Interlaken, Switzerland

11. Department of Medicine, Duke University and Duke-Margolis Center for Health Policy, Durham, North Carolina

12. Federal Statistical Office, Neuchâtel, Switzerland

13. National Institute for Cancer Epidemiology and Registration, National Agency for Cancer Registration, University of Zurich, Switzerland

14. Nursing Science, Department of Public Health of Basel, Switzerland

Abstract

ImportanceWhether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial.ObjectiveTo evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity.Design, Setting, and ParticipantsThis multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022.InterventionAfter a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning.Main Outcomes and MeasuresMixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals.ResultsThere were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by −0.344 hr/mo (95% CI, −0.599 to −0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (−0.034 hr/mo; 95% CI, −0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, −0.011 hr/mo; 95% CI, −0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by −0.879 hr/mo (95% CI, −1.607 to −0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time.Conclusions and RelevanceIn this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge.Trial Registrationisrctn.org Identifier: ISRCTN83274049

Publisher

American Medical Association (AMA)

Subject

General Medicine

Cited by 5 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3