Physicians who visit patients after hospital stay give better discharge plans, study finds

When resident physicians visit former hospital patients' homes, they can better evaluate patient needs and understand how community services keep patients out of hospitals, a study published in Gerontology & Geriatrics Education found.

Residents often develop patients' discharge plans during their training programs and often don't make a home visit after discharge to assess if the plan worked. Many residents never see their patients again.

For the study, 39 internal medicine residents from Boston Medical Center participated in a post-hospital discharge home visit to older patients. Through these visits, the residents reviewed their discharge plan and assessed its effectiveness, identifying parts that did and did not work.

"After visiting the home, the residents were better able to understand what makes for a good hospital discharge of an older patient," said corresponding author Megan Young, MD.

The researchers asked the residents what they learned after finishing the exercise. These residents better assessed patient needs, pointing to a need for more individualized discharge plans related to in-home functioning, caregiver communication and medication reconciliation, the study found. 

"By being able to go into the patient's home and see what services patients need [home- delivered meals, grab bars in the shower, medication delivery systems], we as doctors are able to provide more comprehensive care plans that allow community-dwelling older adults to stay in their home and out of the hospital," Dr. Young said.

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