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Annually more than 1 million patients are hospitalized with a primary diagnosis of heart failure accounting for a total Medicare expenditure exceeding $17 billion (Desai, 2012).

A care coordination measure im­proved quickly (average annual rate of change >10% per year) are hospital pa­tients with heart failure who were given complete written discharge instructions.

  • Effective care coordination begins by ensuring that accurate clinical information is available to support medical decisions by patients and providers.
  • A common transition of care is hospital discharge.
  • A successful transition depends on whether hospitals have adequately educated patients about key elements of care, such as diagnosis and follow-up plans (Horwitz, et al., 2013).

Trends for patients with heart failure given complete written discharge planning instructions:

  • From 2005 to 2013, the percentage of hospitalized adult patients with heart failure who were given complete written discharge instructions improved from 57.4% to 94.6%.
  • Improvements were observed among both sexes and all racial/ethnic groups.

Groups with disparities:

  • In all years, there were no statistically significant differences by sex.
  • In all years, the percentage of hospitalized adult patients with heart failure who were given complete written discharge instructions was lower for American Indians and Alaska Natives (AI/ANs) than for Whites.

Achievable benchmark:

  • The 2012 top 5 State achievable benchmark was 96.2%. The top 5 States that contributed to the achievable benchmark are Illinois, Maine, New Hampshire, New Jersey, and Ohio.
  • At the current rates of increase, this benchmark could be attained overall and by both sexes in less than a year. All racial/ethnic groups could attain the benchmark in less than a year except AI/ANs, who could achieve the benchmark in about 1 year.

Importance: Health care provider-patient communication about prognosis and preferences for care is critical in helping patients adequately prepare for and plan future care, and physicians’ communication style may affect pa­tients’ satisfaction, trust, willingness to cooperate, and health status.

In comparison, patients with heart failure not receiving complete written discharge planning instructions:

Trends:

  • From 2009 to 2014, the percentage of adult hospital patients who did not receive good communication about discharge information improved from 15.8% to 11.3%.
  • From 2009 to 2014, improvements were observed among all racial and age groups.

Groups with disparities:

  • In all years, Black and Asian patients were less likely than White patients to receive good communication about discharge information.
  • In all years except 2012, AI/AN patients were less likely than White patients to receive good communication about discharge information.

Importance: Comprehension of and compliance with discharge instructions can reduce emergency department visits and rehospitalizations, improve post-discharge health outcomes, and decrease health care expenditures.

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