A hospital discharge summary and the medications a patient is actually taking at home aren't always the same list. The gap between them is where a lot of care transitions research has focused, because it's a point where things can go wrong.
A 2005 study in Archives of Internal Medicine followed 375 adults aged 65 and older discharged within a single Colorado managed care system. A geriatric nurse practitioner assessed each patient's medications at home 24 to 72 hours after discharge. A total of 14.1% of patients had at least one medication discrepancy.
The researchers then categorized what contributed to those discrepancies. Of the contributing factors they identified, 50.8% were patient-associated and 49.2% were system-associated. On the patient side, the single largest factor was unintentional nonadherence, at about 34% of all factors. On the system side, incomplete, inaccurate, or illegible discharge instructions accounted for about 16%, and conflicting information from different sources for 14.5%.
The discrepancies weren't just a paperwork problem. Among patients with a medication discrepancy, 14.3% were rehospitalized within 30 days, compared with 6.1% of patients without one (P = .04). That is an association, and the study does not show that the discrepancies caused the readmissions. A higher number of medications and a diagnosis of congestive heart failure were both associated with greater risk.
A related 2013 study of 237 recently discharged older adults, also built on a home visit, found that health literacy, cognition, and self-efficacy were important predictors of whether patients understood and carried out their discharge instructions. Neither the discharge diagnosis nor the complexity of the instructions was a significant predictor.
The 2005 study's authors noted their sample came from one health system in the Denver area, was predominantly white and relatively well educated, and had prescription drug coverage, so how well these figures generalize elsewhere isn't known. What the two studies together suggest is that the risk at a care transition isn't concentrated in any one place. It's split between what the patient does with the instructions and what the instructions themselves actually communicate.
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