Evaluation of a Discharge Clinic Implemented for Patients Without a Primary Care Provider or Access to Their Primary Care Provider
Year of Publication
Doctor of Nursing Practice
Dr. Debra Hampton
Dr. Roberto Cardarelli
Dr. Jean Edward
Background: Patients transitioning from an inpatient hospital stay to self-care responsibilities post-discharge are at risk for readmission resulting in increased cost and resource utilization. Care transition programs can result in cost avoidance and decreased resource utilization.
Purpose: The purposes of this project were to: (a) determine if implementation of a Discharge Clinic affected 30-day readmission rates in patients without a primary care provider, (b) ascertain if a visit by a paramedicine program paramedic impacted 30-day readmission rates in patients who missed their Discharge Clinic appointment, and (c) find out whether a second post-discharge phone call influenced 30-day readmission rates.
Method: A single-center, retrospective exploratory design was employed in this study. Participants included discharged patients (N=727) from a hospital inpatient stay without a primary care provider or without access to their primary care provider who were scheduled for a Discharge Clinic care transitions appointment. Data was collected from November 2021 to November 2022 to determine the impact of a Discharge Clinic visit on 30-day readmission rates. Patients were either called by a transition of care nurse or visited by a paramedicine paramedic following their Discharge Clinic appointment and further data analysis (Chi-Square, Logistic Regression) included whether or not these interventions impacted 30-day readmission rates.
Results: The overall sample size for this study was 727 patients. Readmission rates were 17.7% (n=452) for those who completed a discharge appointment, compared to 24.7% (n=275) for those who did not. Participants who completed their Discharge Clinic appointment received a follow-up call after their appointment. Those participants who completed this call had a 4% readmission rate compared to 26% for those who did not (pOR = 0.64, 95% CI = 0.44 – 0.92, p = .017).
Conclusion: A completed Discharge Clinic appointment was effective in reducing 30-day readmission rates as was a second TOC call. The community paramedicine program collaboration showed promise in reducing 30-day readmission rates although further research is needed. Identifying interventions that improve 30-day readmission rates is imperative for improving outcomes, reducing resource utilization, and avoiding penalties in value-based programs.
Sass, Jessica, "Evaluation of a Discharge Clinic Implemented for Patients Without a Primary Care Provider or Access to Their Primary Care Provider" (2023). DNP Projects. 413.