Communication Research
Conditions
Keywords
Discharge instructions, Non-English language preference, Adapting hospital discharge
Brief summary
Hospital discharge is a dangerous time for patients: one in five will suffer an adverse event, such as a medication error, and nearly 25% will be readmitted within 30 days. This time is even more dangerous for patients with who face communication barriers, including those with non-English language preference (NELP), low health literacy, and the elderly. The investigators will pilot a post-discharge educational intervention to reinforce written discharge instructions (known as the After Visit Summary or AVS) using a randomized controlled trial design (2:1 intervention: control). The control group will receive current standard of care discharge education which includes a nurse reviewing their AVS and an automated call in English that allows patients to numerically select types of problems/questions that are then escalated to a nurse who should return their call within a few days. The intervention group will receive the standard of care discharge education with the AVS and an additional post-discharge educational call delivered by a registered nurse or other qualified health professional with the option to have written instructions professionally translated and sent via MyChart message--if available in their preferred language.
Interventions
OTHERAdditional post discharge phone call
24-72 hours after hospital discharge, a nurse will call participants to review the written After Visit Summary (AVS) given at discharge, including primary diagnosis, self-care instructions, emergency plan, medication changes, how and why to take medication, and scheduled follow up. These phone calls will take on average 10-15 minutes.
Sponsors
Boston Medical Center
National Institute on Minority Health and Health Disparities (NIMHD)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Two arm randomized controlled trial (2:1 intervention:control), Randomization stratified by language.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Registered language in Epic (written or spoken) is Spanish, Haitian Creole, Portuguese, Cape Verdean, or Vietnamese * Admitted to medicine team at Boston Medical Center (BMC) * Being discharged home (to the community)
Exclusion criteria
* On airborne infections precautions at time of recruitment * On C diff precautions at time of recruitment * On suicide precautions at time of recruitment * Nurse report of participant displaying cognitive impairment, ongoing delirium, or aggression * Discharge observed during a prior admission
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Retention success by linguistic group | 12 months | Number of enrolled participants who completed all study assessments stratified by linguistic group. |
| Fidelity to the intervention | 12 months | The number of scheduled educations calls that were completed for participants in the intervention arm based on nursing documentation in Epic. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Acceptability of the intervention | 12 months | The Acceptability of Intervention Measure (AIM) will be completed by participants in the intervention arm to assess acceptability. It has four questions with 5 Likert responses where 1 = Completely disagree, 2 = Disagree, 3 = Neither agree nor disagree, 4 = Agree, 5 = Completely agree, The range of scores from 4 to 20 with higher scores indicating greater acceptability. |
| Feasibility of the intervention | 12 months | Feasibility will be assessed by the number of participants in the intervention arm whose educational call was language concordant based on nursing documentation in Epic. |
| Patient Understanding of Discharge Instruction (UDI) Scale | 12 months | Assessed by a composite score of six key domains of discharge instructions (primary diagnosis, self-care instructions, return precautions, medication changes, medication indications, follow-up) as determined by physician adjudicators (1=poor, 4 = near perfect). Higher scores demonstrate better understanding. |
Countries
United States
Contacts
CONTACTKirsten Austad, MD MPH
CONTACTKhushbu Patel, MA
PRINCIPAL_INVESTIGATORKirsten Austad, MD MPH
Boston Medical Center, Family Medicine
Outcome results
None listed