Effect of standardized electronic discharge instructions on post-discharge hospital utilization

background: Several physician organizations and the Centers for Medicare and Medicaid Services (CMS) support compliance measures for written discharge instructions. CMS has identified clear discharge instructions with specific attention to medication management as a necessary intervention. Objective: We tested the hypothesis that implementing a standardized electronic discharge instructions document with embedded computerized medication reconciliation would decrease post-discharge hospital utilization. Design: Retrospective pre- and post-implementation comparison cohort study. Patients: Subjects were hospitalized patients age 18 and older discharged between November 1, 2005 and October 31, 2006 (n=16,572) and between March 1, 2007 and February 28, 2008 (n=17,516). Intervention: Implementation of a standardized, templated electronic discharge instructions document with embedded computerized medication reconciliation on December 18, 2006. MAIN Measures: The primary outcome was a composite variable of readmission or Emergency Department (ED) visit within 30 days of discharge. Secondary outcomes were the individual variables of readmissions and ED visits within 30 days. Key Results: The implementation of standardized electronic discharge instructions with embedded computerized medication reconciliation was not associated with a change in the primary composite outcome (adjusted OR 1.04, 95% CI 0.98-1.10) or the secondary outcome of 30-day ED visits (adjusted OR 0.98, 95% CI 0.98-1.10). There was an unexpected small but statistically significant increase in 30-day readmissions (adjusted OR 1.08, 95% CI 1.01-1.16). Conclusions: Implementation of standardized electronic discharge instructions was not associated with reduction in post-discharge hospital utilization. More studies are needed to determine the reasons for postdischarge hospital utilization and to examine outcomes associated with proposed process-related recommendations.