Real-life implementation of guidelines on the hospital-to-home transition for older patients: a cohort study in general practice.

Abstract

hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7days. The relevance and feasibility of these guidelines have not previously been assessed. to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors' association with 30-day readmissions. a prospective multicentre cohort study. primary care (general practice) in France. a sample of GPs and the same number of patients aged 75 or over having consulted within 30days of hospital discharge. the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses. seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53-76) consulted their GP within 7days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27-50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07-0.91]). compliance with the French guidelines on hospital-to-home transitions is insufficient.