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Research
Implementation, Spread and Impact of the Patient Oriented Discharge Summary (Pods) Across Ontario Hospitals: A Mixed Methods Evaluation
Shoshana Hahn-Goldberg
University Health Network
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7016-5295
License:
This work is licensed under a CC BY 4.0 License. Read Full License
BACKGROUND
Traditional discharge processes lack a patient-centred focus. This project studied the implementation and effectiveness of an individualized discharge tool across Ontario hospitals. The Patient Oriented Discharge Summary (PODS) is an individualized discharge tool with guidelines that was co-designed with patients and families to enable a patient-centred process.
METHODS
Twenty one acute-care and rehabilitation hospitals in Ontario, Canada engaged in a supported community of practice and worked over a period of 18 months to implement PODS. An effectiveness-implementation hybrid design using a triangulation approach was used with hospital-collected data, patient and provider surveys, and interviews of project teams. Key outcomes included: reach within and spread outside target populations, change in patient-centred processes, patient and provider experience, understanding of discharge instructions, and healthcare utilization. Statistical methods included linear mixed effects models and generalized estimating equations.
RESULTS
Of 65,221 discharges across hospitals, 41,884 patients (64%) received a PODS. There was variation in reach and implementation pattern between sites, though none of the between site covariates was significantly associated with implementation success. Both high participation in the community of practice and scoring highly on quality of PODS were associated with higher implementation success. PODS improved family involvement during discharge teaching (7% increase, p=0.026), use of teach-back (11% increase, p<0.001) and discussion of help needed (6% increase, p=0.041). Although unscheduled healthcare utilization decreased with PODS implementation, it was not statistically significant.
CONCLUSIONS
This project highlighted the system-wide adaptability and ease of implementing PODS across multiple patient groups and hospital settings. PODS demonstrated an improvement in patient-centred discharge processes linked to quality standards and health outcomes. A community of practice and high quality content may be needed for successful implementation.
Keywords
Implementation, Discharge, Patient Centred, Transitions in Care, Local Adaptability, triangulation, Patient Experience, Quality Improvement, Hospital
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Research
Implementation, Spread and Impact of the Patient Oriented Discharge Summary (Pods) Across Ontario Hospitals: A Mixed Methods Evaluation
Shoshana Hahn-Goldberg
University Health Network
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7016-5295
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 22 Sep, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
License:
This work is licensed under a CC BY 4.0 License. Read Full License
BACKGROUND
Traditional discharge processes lack a patient-centred focus. This project studied the implementation and effectiveness of an individualized discharge tool across Ontario hospitals. The Patient Oriented Discharge Summary (PODS) is an individualized discharge tool with guidelines that was co-designed with patients and families to enable a patient-centred process.
METHODS
Twenty one acute-care and rehabilitation hospitals in Ontario, Canada engaged in a supported community of practice and worked over a period of 18 months to implement PODS. An effectiveness-implementation hybrid design using a triangulation approach was used with hospital-collected data, patient and provider surveys, and interviews of project teams. Key outcomes included: reach within and spread outside target populations, change in patient-centred processes, patient and provider experience, understanding of discharge instructions, and healthcare utilization. Statistical methods included linear mixed effects models and generalized estimating equations.
RESULTS
Of 65,221 discharges across hospitals, 41,884 patients (64%) received a PODS. There was variation in reach and implementation pattern between sites, though none of the between site covariates was significantly associated with implementation success. Both high participation in the community of practice and scoring highly on quality of PODS were associated with higher implementation success. PODS improved family involvement during discharge teaching (7% increase, p=0.026), use of teach-back (11% increase, p<0.001) and discussion of help needed (6% increase, p=0.041). Although unscheduled healthcare utilization decreased with PODS implementation, it was not statistically significant.
CONCLUSIONS
This project highlighted the system-wide adaptability and ease of implementing PODS across multiple patient groups and hospital settings. PODS demonstrated an improvement in patient-centred discharge processes linked to quality standards and health outcomes. A community of practice and high quality content may be needed for successful implementation.
Figure 1
Figure 2
Figure 3