Real-life implementation of guidelines on the hospital-to-home transition for older patients: a cohort study in general practice

Abstract

Background: hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7 days. The relevance and feasibility of these guidelines have not previously been assessed.

Objective: to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors' association with 30-day readmissions.

Design: a prospective multicentre cohort study.

Setting: primary care (general practice) in France.

Subjects: a sample of GPs and the same number of patients aged 75 or over having consulted within 30 days of hospital discharge.

Methods: the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7 days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses.

Results: seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53-76) consulted their GP within 7 days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27-50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07-0.91]).

Conclusions: compliance with the French guidelines on hospital-to-home transitions is insufficient.

Keywords: aged; continuity of patient care; general practice; older people; patient discharge; patient readmission.