PDTK

Background

Approximately 19-23% of hospitalized patients experience preventable adverse events (AEs) are leaving the hospital. Though there are 35 million patient discharges each year, efforts to standardize the discharge process have not been focused on patients. Low patient engagement may contribute to preventable AEs and hospital readmissions.

Study Goals

Our AHRQ-funded study aimed to implement and evaluate a set of digital health tools integrated with our institution’s electronic health records (EHR) system, focusing on an interactive patient discharge toolkit (PDTK) that engages patients and caregivers during hospital discharge preparation.

Using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), the objectives were to:

1. Refine and implement the PDTK for patient and caregiver use on general medicine units;
2. Pilot the toolkit to assess its impact on patient activation, as measured by the Patient Activation Measure 13 (PAM-13) at discharge and 30 days post-discharge;
3. Evaluate healthcare resource utilization 30 days post-discharge; and
4. Identify barriers and facilitators to the toolkit’s implementation and use through both qualitative and quantitative methods.

Our Approach

This was a pre-post study with 358 adult patients admitted to general medicine service at the hospital for at least 24 hours who were about to be discharged. The patients were enrolled by a research assistant who guided them through using our discharge preparation tools, including a video, checklist, and messaging system.

During the intervention, clinicians monitored patient-reported concerns in real-time through an integrated safety dashboard. Our research team collected data via surveys at discharge and 30 days after, and tracked how often patients used the tools. Our research team also conducted interviews and focus groups with patients and clinicians for additional feedback.

Results

We compared patient activation scores before and after the intervention, using simple statistics for demographics and usage data. We also analyzed interviews for common themes.

There were some limitations, like the non-randomized design and short-term variability in scores. There was a non-significant increase in the proportion of activated patients at discharge, and a significant increase in PAM scores at discharge. There was no significant change for post-discharge healthcare resource utilization.