Monday, July 25, 2011

CKM and Readmissions

The Journal of General Internal Medicine recently published my paper examining the effects of standardized discharge instructions on readmission. Readers may be surprised that standardizing our discharge instructions to meet consensus recommendations did not reduce readmissions.

However, in light of the necessity of providing actionable knowledge to improve decision making, these findings begin to make sense.

The standardization of the discharge instructions focused on insuring that a set of recommended components (ie: discharge medications, follow-up appointments, contact information, etc.) were always provided to the patient at the time of discharge. On the continuum from data to actionable knowledge, these components are information. Although patients can often synthesize these various information points into knowledge, good decision making is born of actionable knowledge. To move from information, to knowledge, to actionable knowledge, you first have to understand the question that discharge instructions are trying to answer: how should I take care of myself outside of the hospital so that I don't have to come back? 

In light of this question, actionable knowledge is based on an understanding of the patient's own health and disease processes as well as the actions necessary to maintain their health. The capacity to understand and perform these actions is highly variable among patients. Therefore, interventions to prevent readmission need to be customized to each individual patient rather than standardized.

Whether these customized interventions will be time efficient and cost effective has not yet been determined. However, in my opinion, discharge interventions that are not customized to the patient will continue to show lackluster results.

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